It is now—at least loosely—acknowledged that most health and clinical outcomes are influenced by different interacting causes. Surprisingly, medical research studies are nearly universally designed to study—usually in a binary way—the effect of a single cause. Recent experiences during the coronavirus disease 2019 pandemic brought to the forefront that most of our challenges in medicine and healthcare deal with systemic, that is, interdependent and interconnected problems. Understanding these problems defy simplistic dichotomous research methodologies. These insights demand a shift in our (...) thinking from ‘cause and effect’ to ‘causes and effects’ since this transcends the classical way of Cartesian reductionist thinking. We require a shift to a ‘causes and effects’ frame so we can choose the research methodology that reflects the relationships between variables of interest—one-to-one, one-to-many, many-to-one or many-to-many. One-to-one (or cause and effect) relationships are amenable to the traditional randomized control trial design, while all others require systemic designs to understand ‘causes and effects’. Researchers urgently need to re-evaluate their science models and embrace research designs that allow an exploration of the clinically obvious multiple ‘causes and effects’ on health and disease. Clinical examples highlight the application of various systemic research methodologies and demonstrate how ‘causes and effects’ explain the heterogeneity of clinical outcomes. This shift in scientific thinking will allow us to find the necessary personalized or precise clinical interventions that address the underlying reasons for the variability of clinical outcomes and will contribute to greater health equity. (shrink)

In this paper we argue that knowledge in health care is a multidimensional dynamic construct, in contrast to the prevailing idea of knowledge being an objective state. Polanyi demonstrated that knowledge is personal, that knowledge is discovered, and that knowledge has explicit and tacit dimensions. Complex adaptive systems science views knowledge simultaneously as a thing and a flow, constructed as well as in constant flux. The Cynefin framework is one model to help our understanding of knowledge as a personal construct (...) achieved through sense making. Specific knowledge aspects temporarily reside in either one of four domains – the known, knowable, complex or chaotic, but new knowledge can only be created by challenging the known by moving it in and looping it through the other domains. Medical knowledge is simultaneously explicit and implicit with certain aspects already well known and easily transferable, and others that are not yet fully known and must still be learned. At the same time certain knowledge aspects are predominantly concerned with content, whereas others deal with context. Though in clinical care we may operate predominately in one knowledge domain, we also will operate some of the time in the others. Medical knowledge is inherently uncertain, and we require a context-driven flexible approach to knowledge discovery and application, in clinical practice as well as in health service planning. (shrink)

"Every man has his particular way of being in good health" - Emanuel Kant. Emanuel Kant's description of health stands in stark contrast to accepted definitions of health. For example, the WHO defines ‘health’ as ‘a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’. However, as people get on with day-to-day living, no one can achieve the goal of ‘complete physical, mental and social well-being’. It is odd to define ‘health’ as (...) a negative state that puts it beyond the reach of everyone. This paper explores the idea of health being a personal state, health being the product of every man's particular way of making sense of his particular circumstances. (shrink)

We are never illness or disease, but, rather, always their sum in the world of day-to-day experience. Disease and illness are not closed systems, but mutually constitutive and continuously interacting worlds. In the patient’s case it is always experience as well. Pain, sickness and death help make that particular experienced identity unavoidable, and at some level ultimately inaccessible to medicine’s changing understanding of disease and tools for managing it. Health—rather than cost containment, specific conditions, or technologies—should be the central focus (...) for health care and health-care reform. A compelling reason to focus on health comes from the observation that the prevalence of disease over the .. (shrink)

When natural time sequences were replaced by clocks, time became a measurable commodity and the ‘speedy use of time’ a virtue. In medical practice shorter consultations allow more patients to be seen, whereas longer consultations result in a better understanding of the patient and her problems. Crossing the line of time-efficiency and time-effectiveness compromises the balance between short-term turnover and long-term outcomes. The consultation has all the hallmarks of a complex adaptive system whose characteristics are not determined by the characteristics (...) of the components, but by the patterns of interaction among the components. Systems are dynamic and change over time; the dynamic nature is not incidental, but necessary as complex systems operate at conditions far from equilibrium. The central notion when we talk of time and complexity is that of ‘memory’. Memory is carrying something from the past over into the future. Memory is filtered/interpreted, separating noise from information. Memory therefore is not an instantaneous thing, it takes time to develop; it is slow. The dynamics between the participating agents in the consultation will create shared memories that live on to shape future interactions. Shared memories are stronger and contain more relevant knowledge if they are based on frequent interactions and ongoing doctor–patient relationships, leading to a better understanding of the whole person – a process that takes time. Sufficient time, that is, ‘a certain slowness’, is an essential element of the healing relationship in the consultation. It creates a sufficiently stable, but adaptive, environment that can withstand changing demands. Hence a more complete understanding of the consultation and its time demands will not only lead to more effective treatment, it will also humanize a situation which has become to a large extent purely instrumental. This process of humanization is important not only for the patient, but also for the doctor. (shrink)

Background Metaphors are central to the human understanding of complex issues; through the immediate associations they evoke and frame problems and suggest solutions. Our suggestion of Music in the Park as a metaphor for health systems reform brings to the forefront the environmentally diverse but bounded spaces of health services that offer a variety of attractors within their confines, while pushing into the background organizational and economic concerns.Reflections Parks, like health services, are embedded in their local landscape, serving their communities, (...) but most importantly parks are public spaces, publically funded, ideally offering universal access and equity and to be shared by all who want to go there.Music, like health, is tangible, technical and scientific, yet ultimately experiential and based on meaning. While it encompasses a wide range of styles and approaches, music making requires as its most important skill active listening which brings with it to be ‘in the moment’, to take personal risks and to draw energy and inspiration from the participants. Hence ‘audiences’ are equally active participants because music only has meaning if it internally resonates with the listener and only can exist in what is a co-constructed experience.Conclusions Music in the Park is a metaphor for primary health care systems based on shared values of experts and unique local communities. Health professionals are players in this arena, who develop and practise the full range of their skills in response to individual and community needs and preferences. Their leadership works through inspiration and empowerment, making patients ‘co-producers’ of their own health and ‘co-shapers’ of their health services. (shrink)

Incorporating significant editorial changes from earlier editions, the fourth edition of Ludwig Wittgenstein's _Philosophical Investigations_ is the definitive _en face_ German-English version of the most important work of 20th-century philosophy The extensively revised English translation incorporates many hundreds of changes to Anscombe’s original translation Footnoted remarks in the earlier editions have now been relocated in the text What was previously referred to as ‘Part 2’ is now republished as _Philosophy of Psychology – A Fragment_, and all the remarks in it (...) are numbered for ease of reference New detailed editorial endnotes explain decisions of translators and identify references and allusions in Wittgenstein's original text Now features new essays on the history of the _Philosophical Investigations_, and the problems of translating Wittgenstein’s text. (shrink)

A. L. Kroeber, who together with C. Kluckhohn wrote a now classical review of the concept of culture (1958), claimed that the most significant accomplishment of anthropology in the first half of the twentieth century was the extension and clarification of the concept of culture. In the book mentioned they analyzed about 300 different definitions of the concept. In a critical review of Kroeber's and Kluckhohn's book their colleague L. A. White contests Kroeber's claims and writes: “On the contrary, I (...) believe that confusion has increased as conceptions of culture have been multiplied and diversified” (1954, p. 461). (shrink)

Auf der Grundlage des von P. Janich vorgelegten Buches "Die Protophysik der Zeit" wird eine immanente Kritik an einem Teil des protophysikalischen Programmes formuliert. Dabei werden außer den von den Vertretern der Protophysik zugestandenen keine weiteren Hilfsmittel verwendet. Darüber hinaus wird die Protophysik mit dem Prinzip der Relativität konfrontiert. Es zeigt sich, daß die von Janich geforderte Normierung bezüglich der Zeitmessung zwar eine prinzipiell und auch materiell realisierbare Möglichkeit darstellt, eine apriorische Notwendigkeit zur Verwendung dieser Zeitmessung in der Physik daraus (...) jedoch nicht abgeleitet werden kann. Von dieser Feststellung ausgehend wird verdeutlicht, daß die von Seiten der Protophysik gegen die spezielle Relativitätstheorie vorgebrachte Polemik unbegründet ist und auf einer Fehlinterpretation des Ausdrucks 'Invarianz von Naturgesetzen gegenüber Bezugssystemtransformationen' beruht. (shrink)

v. A. -- v. B. -- v. C/D. -- v. E/F. -- v. G. -- v. H. (2 pts.) -- v. IJK. -- v. Kant . (2 pts.) -- v. L. -- v. M. (2 pts.) -- v. N/O. -- v. P/Q. (2 pts.).

The Historical Dictionary of Philosophy, the _Historisches Wörterbuch der Philosophie,_ is distinguished by its particular presentation of philosophical terms, ideas and concepts. Rather than providing mere defintions or descriptive and analytical explanantions the _HWPh_ strictly applies the critical method of history of concepts developed by the eminent German scholar and philosopher Joachim Ritter. By means of precise and detailed references it documents the origin, first occurrence, the historical evolution and the changes of meaning of each concept, from Ancient Greek (...) to contemporary philosophy. For the reader this presentation is of unique value: it makes traceable the importance of terms and concepts at certain periods or for a particular philosopher, as well as its changes and development of meaning. (shrink)

In his “On the Metaphysics of Knowledge” (this volume), Sven Bernecker presents a novel ‘identificationist’ account of knowledge. In this paper, I will not directly address the epistemological adequacy of Bernecker’s identificationism. Rather, I want to focus on its substantial metaphysical commitments, especially on the problematic idea that our epistemic reasons identify the truthmaker of our respective belief when we know something. My conclusion will be that being a truthmaker for p is metaphysically more demanding than being an epistemic reason (...) for p. A truthmaker for p must necessitate the truth of p, while an epistemic reason for p must merely indicate the truth of p. Thus, we should not expect that epistemic reasons identify the truthmakers of our knowledge-constituting beliefs in the way Bernecker suggests. (shrink)

In einem auf drei Bände angelegten Dokumentationswerk werden Entstehung und Ausbreitung des Paracelsismus in den kontroversen Verflechtungen der Wissenschafts-, Literatur- und Sozialgeschichte des späten 16. Jahrhunderts verankert. Die kritische Edition aufschlußreicher, oft in unbekanntes Terrain führender Texte ist begleitet von umfangreichen Kommentaren sowie von biographischen Darstellungen der Urheber, Adressaten, Gegner bzw. Sympathisanten der paracelsistischen Reform und Protestbewegung. Der zweite Band des »Corpus Paracelsisticum« erschließt das weitläufige Oeuvre von Michael Toxites und Gerhard Dorn, wirkmächtige Gründergestalten des oberrheinischen Paracelsismus. Von da aus (...) fällt der Blick quer über die Konfessionsgrenzen auf andere kulturelle Zentren in Bayern, Sachsen, Schlesien, Böhmen und am Niederrhein. Mit Verfassern wie G. Fedro, M. Ambrosius, L. Span, B. Flöter, G. Etschenreutter, B. Scultetus, P. Perna, Th. Zwinger und J. Albrecht eröffnet sich ein epochaler, äußerst weitläufiger Diskurszusammenhang. In ihm lassen sich doxographische, methodische, hermeneutische, sprachtheoretische und überlieferungsspezifische Auseinandersetzungen ebenso beobachten wie Tendenzen einer theosophischen Spiritualisierung und heterodoxen Aufladung der in Paracelsus' Namen entwickelten Anthropologie und Kosmologie. Direkte Verbindungen ergeben sich unter anderem zu führenden Vertretern der sogenannten Schwenckfelder, damit auch zu Fraktionen aktiver protestantischer Dissidenten. Der Band wird neben dem weiterführenden Kommentar begleitet von einer ausführlichen Einleitung und erschlossen nicht nur durch mehrere Register, sondern auch durch wissenschaftshistorische Zusammenfassungen zu jedem Autorcorpus. (shrink)

Des Herrn Doct. und Prof. Joachim Langens, oder, Der Theologischen Facultaet zu Halle Anmerckungen über des Herrn Hoff-Raths und Professor Christian Wolffens Metaphysicam ... nebst beygefügter Hr. Hoff-R. und Prof. Christian Wolffens gründlicher Antwort -- Herrn D. Joh. Francisci Buddei S.S. Theol. P.P.O. zu Jena Bedencken über die Wolffianische Philosophie, mit Anmerckungen erläutert von Christian Wolffen.

Nanotechnology has from its very beginning been surrounded with an aura of novelty. For instance, on the 28 introductory pages of the report that prepared the US National Nanotechnology Initiative (NNI), Nanotechnology Research Directions (NSTC/IWGN 1999), we read 73 times the term “new”, 15 times “novel”, 7 times “innovation”, and 21 times “revolution”. The authors concede that one should distinguish between different nanotechnologies, because “Many existing technologies do already depend on nanoscale processes. Photography and catalysis are two examples of ‘old’ (...) nanotechnologies” (ibid, p. xxvi). One might conclude here that, if all the existing nanotechnologies are “old” nanotechnologies, “new” nanotechnologies do not yet exists but are only promises of the future. However, without further explanation and distinction between presence and future, they suggest that most nanotechnologies are or will be new. Furthermore, they claim that nanotechnology (in singular) is a generator of further new technologies, since “Nanotechnology will give birth to new fields that at present are only visions of leading researchers” (ibid., p. xviii). Whenever science managers speak of nanotechnology (in singular), sophisticated distinctions seem to give way to plain claims about the present and future novelty of nanotechnology. As the NNI director Mihail Roco wrote in a 2001 report, “A revolution is occurring in science and technology […] Nanotechnology will fundamentally transform science, technology, and society. In 10 to 20 years, a significant proportion of industrial production, healthcare practice, and environmental management will be changed by the new technology.” (Roco & Bainbridge, pp. 1, 19) When they put on their hats as science managers, scientists rarely reject but mostly support such novelty claim, as did for instance the chemists George Whitesides and Paul Alivisatos in the earlier report: “Nanostructures are the entry into a new realm in physical and biological science.” (NSTC/IWGN 1999, p.. (shrink)

Abstract.In this paper we show that the theory of fields together with an integrally closed subring, the theory of formally real fields with a real holomorphy ring and the theory of formally \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $p$\end{document}-adic fields with a \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document} $p$\end{document}-adic holomorphy ring have no model companions in the language of fields augmented by a unary predicate for the corresponding ring.

As supposed in the last Editorial (HYLE, 5-1, p. 78), our special topic ‘Models in Chemistry’ has attracted new attention to the philosophy of chemistry. Only during the past couple of month, the number of visitors of the HYLE website has nearly doubled to some 1,600 per month. There is nothing comparable in the whole field of philosophy of science, as there is no other science having such a lot to catch up on philosophical work. At the same time, this (...) means a great challenge to meet the expectation of such a large and heterogeneous readership. (shrink)

Contents: Foreword. Wolfgang BALZER and C. ULISES MOULINES: Introduction. José A. DÍEZ CALZADA: Structuralist Analysis of Theories of Fundamental Measurement. Adolfo GARCÍA DE LA SIENRA and Pedro REYES: The Theory of Finite Games in Extensive Form. Hans Joachim BURSCHEID und Horst STRUVE: The Theory of Stochastic Fairness - its Historical Development, Formulation and Justification. Wolfgang BALZER and Richard MATTESSICH: Formalizing the Basis of Accounting. Werner DIEDERICH: A Reconstruction of Marxian Economics. Bert HAMMINGA and Wolfgang BALZER: The Basic Structure of (...) Neoclassical General Equilibrium Theory. Klaus MANHART: Balance Theories: Two Reconstructions and the Problem of Intended Applications. Rainer WESTERMANN: Festinger's Theory of Cognitive Dissonance: A Structuralist Theory-Net. Rainer REISENZEIN: Wundt's Three-Dimensional Theory of Emotion. Pablo LORENZANO: Classical Genetics and the Theory-Net of Genetics. Hinne HETTEMA and Theo A.F. KUIPERS: The Formalisation of the Periodic Table. C. ULISES MOULINES: The Basic Core of Simple Equilibrium Thermodynamics. Thomas BARTELBORTH: An Axiomatization of Classical Electrodynamics. Author's Index. Subject Index. (shrink)

In 2002 the American Chemical Society (ACS) asked its members to submit proposals for the "ten most beautiful experiments in chemistry" (C&EN, Nov. 18, 2002, p. 5) and then proudly published the result of the vote in its Chemical and Engineering News magazine (C&EN, Aug. 25, 2003, pp. 27-30). Democratic as the procedure is, it avoids asking critical questions: What is an experiment? What is beauty? What is chemistry? In fact, you need not be able to give an answer to (...) these questions in order to vote. We could even imagine none of the voters being able to answer any of the questions in explicit terms. And yet, the members of the society might correctly consider the result valid, not only with regard to the top ten list but also regarding its implicit definitions of what ‘experiment’, ‘beauty’, and ‘chemistry’ means. The result thus reflects the tacit knowledge and the unquestioned feelings of the majority, as they have previously been trained to respond to such unusual questions, and helps newcomers to acculturate easily. However, such implicit consensus definitions and assessments are neither binding for non-members, nor suitable for explicit debates. Prompted by the questions of what a beautiful experiment in chemistry is, you might repeat the top ten list you have learnt by heart, but otherwise remain silent. (shrink)

Der zweite Band des "Corpus Paracelsisticum" erschließt das weitläufige Oeuvre von Michael Toxites und Gerhard Dorn, wirkmächtige Gründergestalten des oberrheinischen Paracelsismus. Von da aus fällt der Blick quer über die Konfessionsgrenzen auf andere kulturelle Zentren in Bayern, Sachsen, Schlesien, Böhmen und am Niederrhein. Mit Verfassern wie G. Fedro, M. Ambrosius, L. Span, B. Flöter, G. Etschenreutter, B. Scultetus, P. Perna, Th. Zwinger und J. Albrecht eröffnet sich ein epochaler, äußerst weitläufiger Diskurszusammenhang. Der Band wird neben dem weiterführenden Kommentar begleitet von (...) einer ausführlichen Einleitung und erschlossen durch mehrere Register sowie wissenschaftshistorische Zusammenfassungen zu jedem Autorcorpus. (shrink)

The processes underlying motor decision-making have recently caught considerable amount of scientific attention, focusing on the integration of empirical evidence from sensorimotor control research with psychological theories and computational models on decision-making. Empirical studies on motor decision-making suggest that the kinematics of goal-directed reaching movements are sensitive to the level of target uncertainty during movement planning. However, the source of uncertainty as a relevant factor influencing the process of motor decision-making has not been sufficiently considered, yet. In this study, we (...) test the assumption that the source of target uncertainty has an effect on motor decision-making, which can be proven by analyzing movement variability during the time course of movement execution. Ten healthy young adults performed three blocks with 66 trials of goal-directed reaching movements in each block, across which the source and level of reach target uncertainty at movement onset were manipulated (“no uncertainty”, “extrinsic uncertainty”, “intrinsic uncertainty”). Fingertip position of the right index finger was recorded using an optical motion tracking system. Standard kinematic measures (i.e. path length and movement duration) as well as variability of fingertip position across the time course of movement execution and at movement end were analyzed. In line with previous studies, we found that a high level of extrinsic target uncertainty leads to increased overall movement duration, which could be attributed to increased path length in this condition, as compared to intrinsic and no target uncertainty (all p <.001). Movement duration and path length did not show any differences between the latter two conditions. However, the time course analysis of movement variability revealed significant differences between these two conditions, with increased variability of fingertip position in the presence of intrinsic target uncertainty (Condition × Sampling point: p =.01), though considerably less than under high extrinsic target uncertainty (p ≤.001). These findings suggest that both the level and source of uncertainty have a significant effect on the processing of potential action plans during motor decision-making, which can be revealed through the analysis of the time course of movement variability at the end-effector level. (shrink)