Clinical diagnostic medicine is an experimental science based on observation, hypothesis making, and testing. It is an use dynamic process that involves observation and summary, diagnostic conjectures, testing, review, observation and summary, new or revised conjectures, i.e. it is an iterative process. It can then be said that diagnostic hypotheses are also ‘observation-laden’. My aim is to enlarge on the strategies of medical diagnosis as these are meshed in training and clinical experience—that is, to describe the patterns of reasoning used (...) by experienced clinicians under different diagnostic circumstances and how these patterns of inquiry allow further insight into the evaluation and treatment of patients. I do not aim to present a theory and illustrate it with examples; I wish rather am to let a realistic example, similar to actual clinical scenarios, direct the exposition. To this end, I introduce an account of medical diagnosis—briefly comparing and contrasting it to other accounts—in order to focus on discussing the process of diagnosis through a detailed clinical case. (shrink)

ABSTRACT:How does the diagnosis process work? This essay traces the philosophical underpinnings of diagnosis from Hume through Kant, Peirce, and Popper, analyzing how pathologists amalgamate sensibility, intuition, and imagination to form new hypotheses that can be tested by evidence and experience.

Clinical diagnostic medicine is an experimental science based on observation, hypothesis making, and testing. It is an use dynamic process that involves observation and summary, diagnostic conjectures, testing, review, observation and summary, new or revised conjectures, i.e. it is an iterative process. It can then be said that diagnostic hypotheses are also ‘observation-laden’. My aim is to enlarge on the strategies of medical diagnosis as these are meshed in training and clinical experience—that is, to describe the patterns of reasoning used (...) by experienced clinicians under different diagnostic circumstances and how these patterns of inquiry allow further insight into the evaluation and treatment of patients. I do not aim to present a theory and illustrate it with examples; I wish rather am to let a realistic example, similar to actual clinical scenarios, direct the exposition. To this end, I introduce an account of medical diagnosis—briefly comparing and contrasting it to other accounts—in order to focus on discussing the process of diagnosis through a detailed clinical case. (shrink)

In Zermelo-Fraenkel set theory with the axiom of choice every set has the same cardinal number as some ordinal. Von Rimscha has weakened this condition to “Every set has the same cardinal number as some transitive set”. In set theory without the axiom of choice, we study the deductive strength of this and similar statements introduced by von Rimscha.

We study the relationships between definitions of compactness in topological spaces and the roll the axiom of choice plays in these relationships.

This grounded study investigated the negotiation of authorship by faculty members, graduate student mentors, and their undergraduate protégés in undergraduate research experiences at a private research university in the northeastern United States. Semi-structured interviews using complementary scripts were conducted separately with 42 participants over a 3 year period to probe their knowledge and understanding of responsible authorship and publication practices and learn how faculty and students entered into authorship decision-making intended to lead to the publication of peer-reviewed technical papers. Herein (...) the theoretical model for the negotiation of authorship developed through the analysis of these interviews is reported. The model identifies critical causal and intervening conditions responsible for the coping strategies faculty and students employ, which, in our study, appear to often produce unfortunate consequences for all involved. The undergraduate student researchers and their graduate student mentors interviewed in this study exhibited a limited understanding of authorship and the requirements for authorship in their research groups. The power differential between faculty and students, the students’ limited epistemic development, the busy-ness of the faculty, and the faculty’s failure to prioritize authorship have been identified as key factors inhibiting both undergraduate and graduate students from developing a deeper understanding of responsible authorship and publication practices. Implications for graduate education and undergraduate research are discussed, and strategies for helping all students to develop a deeper understanding of authorship are identified. (shrink)

6. Jürgen Habermas's Critical Hermeneutics Introduction Habermas and Critical Hermeneutics Life and Influences 132 Habermas's Place in Contemporary Thought ...

As policy makers struggle to develop regulatory oversight models for nanotechnologies, there are important lessons that can be drawn from previous attempts to govern other emerging technologies. Five such lessons are the following: public confidence and trust in a technology and its regulatory oversight is probably the most important factor for the commercial success of a technology; regulation should avoid discriminating against particular technologies unless there is a scientifically based rationale for the disparate treatment; regulatory systems need to be flexible (...) and adaptive to rapidly changing technologies; ethical and social concerns of the public about emerging technologies need to be expressly acknowledged and addressed in regulatory oversight; and international harmonization of regulation may be beneficial in a rapidly globalizing world. (shrink)

Nanotechnology is the latest in a growing list of emerging technologies that includes nuclear technologies, genetics, reproductive biology, biotechnology, information technology, robotics, communication technologies, surveillance technologies, synthetic biology, and neuroscience. As was the case for many of the technologies that came before, a key question facing nanotechnology is what type of regulatory oversight is appropriate for this emerging technology. As two of us wrote several years ago, the question facing nanotechnology is not whether it will be regulated, but when and (...) how.Yet, appropriate regulation of nanotechnology will be challenging. The term “nanotechnology” incorporates a broad, diverse range of materials, technologies, and products, with an even greater spectrum of potential risks and benefits. This technology slashes across the jurisdiction of many existing regulatory statutes and regulatory agencies, and does so across the globe. Nanotechnology is developing at an enormously rapid rate, perhaps surpassing the capability of any potential regulatory framework to keep pace. Finally, the risks of nanotechnology remain largely unknown, both because of the multitude of variations in the technology and because of the limited applicability of traditional toxicological approaches such as structure-activity relationship to nanotechnology products. (shrink)

Risk management of nanotechnology is challenged by the enormous uncertainties about the risks, benefits, properties, and future direction of nanotechnology applications. Because of these uncertainties, traditional risk management principles such as acceptable risk, cost–benefit analysis, and feasibility are unworkable, as is the newest risk management principle, the precautionary principle. Yet, simply waiting for these uncertainties to be resolved before undertaking risk management efforts would not be prudent, in part because of the growing public concerns about nanotechnology driven by risk perception (...) heuristics such as affect and availability. A more reflexive, incremental, and cooperative risk management approach is required, which not only will help manage emerging risks from nanotechnology applications, but will also create a new risk management model for managing future emerging technologies. (shrink)

The willows and the hazel copses greenShall now no more be seenFanning their joyous leaves to thy soft lays.[Milton, Lycidas, Ll. 42-44] It is my thesis that the reader is always making sense , and in the case of these lines the sense he makes will involve the assumption of a completed assertion after the word "seen," to wit, the death of Lycidas has so affected the willows and the hazel copses green that, in sympathy, they will wither and die (...) . In other words at the end of line 43 the reader will have hazarded an interpretation, or performed an act of perpetual closure, or made a decision as to what is being asserted. I do not mean that he has done four things, but that he has done one thing the description of which might take any one of four forms—making sense, interpreting, performing perpetual closure, deciding about what is intended. Whatever he has done he will undo it in the act of reading the next line; for here he discovers that his closure, or making of sense, was premature and that he must make a new one in which the relationship between man and nature is exactly the reverse of what was first assumed. The willows and the hazel copses green will in fact be seen, but they will not be seen by Lycidas. It is he who will be no more, while they go on as before, fanning their joyous leaves to someone else's soft lays . Nature is not sympathetic, but indifferent, and the notion of her sympathy is one of those "false surmises" that the poem is continually encouraging and then disallowing. Stanley E. Fish, professor of English at Johns Hopkins University, is the author of John Skelton's Poetry, Surprised by Sin: The Reader in Paradise Lost, and Self-Consuming Artifacts: The Experience of Seventeenth-Century Literature. His other contributions to Critical Inquiry include "Facts and Fictions: A Reply to Ralph Rader" , "Normal Circumstances, Literal Language, Direct Speech Acts, the Ordinary, the Everyday, the Obvious, What Goes without Saying, and Other Special Cases" , "A Reply to John Reichert; or, How to Stop Worrying and Learn to Love Interpretation" , and "One More Time" . See also: "Professor Fish on the Milton Variorum" by Douglas Bush in Vol. 3, No. 1; "Stanley Fish's 'Interpreting the Variorum': Advance or Retreat?" by Steven Mailloux in Vol. 3, No. 1; "Interpreting 'Interpreting the Variorum'" by Stanley E. Fish in Vol. 3, No. 1. (shrink)

One of the major assumptions of John Zaller's RAS model of public opinion is that people need explicit cues from partisan elites in order to evaluate persuasive messages. This puts the public in the position of a passive audience, unable to scrutinize information or make independent decisions. However, there is evidence that people can, under some circumstances, evaluate and use information independently of elite cues. Thus, patterns of public opinion in the months before the Iraq war are inconsistent with the (...) predictions of Zaller's model. While the RAS model usually accounts for the dynamics of public opinion quite well, the situations in which it fails provide us with critical insights into the limits of elite influence. (shrink)

I could go on in this way, replying to Reichert's reply, point by point, but the pattern of my replies is already set: he charges that my position entails certain undesirable consequences and flies in the face of some of our most basic intuitions; I labor to show that none of those consequences follow and that our basic intuitions are confirmed rather than denied by what I have to say. This of course is exactly what I was doing in the (...) article to which he takes exception and will soon do at length in a book to be published within the year. I am not, however, optimistic that a reading of that book will make Reichert a convert because the fears that impel his argument are so basic to his beliefs. I take the key sentence in his article to be this one: "Since I would like to think that I read the same King Lear that Dr. Johnson read, and am therefore free to disagree with his interpretation of it, I would like to find a way out of Fish's formulation of the reader's situation" . Reichert's commitment to what he would like to be able to do and his conviction that if what I say is true he will be unable to do it make it impossible for him to regard my position as anything but perverse and dangerous. Even if I could demonstrate in his own terms that his fears are unfounded—that he is still free to disagree with Dr. Johnson or anyone else—any argument I might make would be received within the belief that it had to be wrong, and within that belief he could only hear it as wrong. To this Reichert would probably reply that arguments are either good or bad, irrespective of beliefs, and that mine are bad; but it is my contention that arguments are forceful only within a set of beliefs and that unless someone is willing to entertain the possibility that his beliefs are wrong he will be unable even to hear an argument that constitutes a challenge to them. That is why the fact that Reichert is likely to remain unconvinced by my argument is its strongest confirmation. Stanley Fish is the author of, among other works, Is There a Text in This Class? Interpretative Authority in the Classroom and in Literary Criticism. His contributions to Critical Inquiry include "Facts and Fictions: A Reply to Ralph Rader" , "Interpreting the Variorum" , "Interpreting 'Interpreting the Variorum'" , "Normal Circumstances, Literal Language, Direct Speech Acts, the Ordinary, the Everyday, the Obvious, What Goes without Saying, and Other Special Cases" , and "One More Time". (shrink)

In this concentrated, intelligible, and useful introductory volume Stanley Porter and Jason Robinson give a splendid overview of hermeneutical and interpretive thought. Neither an all-inclusive survey that moves too quickly over the surface of complex issues nor a specialized volume on a single, narrow topic, Porter and Robinson's Hermeneutics provides critical analysis of major movements and figures in hermeneutics and interpretive theory in the modern era -- from Schleiermacher and Heidegger to Thiselton and Culpepper -- showing especially how these (...) interpreters and their movements have impacted biblical and theological study. (shrink)

In the summer of 1977, as I was preparing to teach Jacques Derrida’s Of Grammatology to a class at the School of Criticism and Theory in Irvine, a card floated out of the text and presented itself for interpretation. It read:WITH THE COMPLIMENTS OF THE AUTHORImmediately I was faced with an interpretive problem not only in the ordinary and everyday sense of having to determine the meaning and the intention of the utterance but in the special sense occasioned by the (...) fact that I didn’t know who the author named or, rather, not named by the card was. It might have been Derrida himself whom I had met, but only in passing. Or it might have been Derrida’s translator, Gayatri Spivak whom I had known for some time and who might well have put me on the publisher’s list. Or it might have been the publisher, in this case the Johns Hopkins University Press of whose editorial board I was then a member. In the absence of any explicit identification, I found myself a very emblem of the difficulties or infelicities that attend distanced or etiolated communication: unable to proceed because the words were cut off from their anchoring source in a unique and clearly present intention. That is to say, I seemed, in the very moment of my perplexity, to be proving on my pulse the superiority of face-to-face communication, where one can know intentions directly, to communication mediated by the marks of writing and in this case by a writing that materialized without any clues as to its context of origin. It may not have been a message found in a bottle, but it certainly was a message found in a book. (shrink)

The uneasy relation between violence and sanctity, between oppression and culture, underlies the dramatic action of Euripides' "Ion." Ion's monody ends with his threatening to shoot the birds who would soil the temple, or in other words, to protect purity through violence and death. The earlier part of his song also shows how the forces of exclusion and domination create sacredness. Ritual silence , restricted access to the aduton, ritual chastity, even the irreversible transformation of natural gardens into laurel brooms (...) and jugs of water all suggest how violence and domination create culture out of nature. The rape of Creusa epitomizes the relation between culture and violence. Her meeting with Ion reveals the psychological cost of social oppression and portrays the imperfect interdependence between moral feelings and legal institutions. Various dramatic devices portray the divisions in Creusa's mind that the injustice has created, devices including self-address, riddling speech, self-restraint, and silence. Her reluctance to pose her bold question to the oracle, and her displacement of the story onto the person of a raped "friend," show her resentful awareness that social institutions collaborate in the oppression. Ion's disillusionment echoes her resentment more theoretically. Together their comments show how moral rules and legal institutions, though fundamentally based on personal feelings such as shame and indignation, enact these feelings only imperfectly; the resulting dissonance in turn leads to further indignation and moral reflection. Finally, the allusions to fifth-century politics in Ion's speech on Athenian politics and elsewhere suggest that democracy itself depends on political domination and imperialism. (shrink)

Importance: Given the importance of apathy for stroke, we felt it was time to scrutinize the psychometric properties of the commonly used Starkstein Apathy Scale for this purpose.Objectives: The objectives were to: estimate the extent to which the SAS items fit a hierarchical continuum of the Rasch Model; and estimate the strength of the relationships between the Rasch analyzed SAS and converging constructs related to stroke outcomes.Methods: Data was from a clinical trial of a community-based intervention targeting participation. A total (...) of 857 SAS questionnaires were completed by 238 people with stroke from up to 5 time points. SAS has 14 items, rated on a 4-point scale with higher values indicating more apathy. Psychometric properties were tested using Rasch partial-credit model, correlation, and regression. Items were rescored so higher scores are interpreted as lower apathy levels.Results: Rasch analysis indicated that the response options were disordered for 8/14 items, pointing to unreliability in the interpretation of the response options; they were consequently reduced from 4 to 3. Only 9/14 items fit the Rasch model and therefore suitable for creating a total score. The new rSAS was deemed unidimensional. Apathy was correlated weakly with anxiety/depression and uncorrelated with physical capacity. Regression showed that the effect of apathy on participation and health perception was similar for rSAS/SAS versions: R2 participation measures ranged from 0.11 to 0.29; R2 for health perception was ∼0.25. When placed on the same scale, rSAS value was 6.5 units lower than SAS value with minimal floor/ceiling effects. Estimated change over time was identical which was not substantial but greater than expected assuming no change.Conclusion: The retained items of the rSAS targeted domains of behaviors more than beliefs and results support the rSAS as a robust measure of apathy in people with chronic stroke. (shrink)

We distinguish three aspects of medical diagnosis: generating new diagnostic hypotheses, selecting hypotheses for further pursuit, and evaluating their probability in light of the available evidence. Drawing on Peirce’s account of abduction, we argue that hypothesis generation is amenable to normative analysis: physicians need to make good decisions about when and how to generate new diagnostic hypothesis as well as when to stop. The intertwining relationship between the generation and selection of diagnostic hypotheses is illustrated through the analysis of a (...) detailed clinical case study. This interaction is not adequately captured by the existing probabilistic, decision-theoretic models of the threshold approach to clinical decision-making. Instead, we propose to conceptualize medical diagnosis in terms of strategic reasoning. (shrink)

Hermeneutics, as a discipline of the humanities, is often assumed to be in thrall to the same subjectivity of every interpretive method, in direct contract to the objectivity prized by the natural sciences. This book argues that there is a false dichotomy here, and that ancient and modern ideas of knowledge can be utilized to create a new active form of hermeneutics. One capable of creating a standard by which to judge better and worse models of understanding. This book explores (...) decisive aspects over which the future of hermeneutics-a future inexplicably tied to a history of hermeneutics-will continue to struggle, namely the limits and possibilities of situated human understanding. This book is located in the middle of a number of major, converging discussions within contemporary intellectual discourse. Drawing upon a wide range of ancient and modern hermeneutical thought, including Aristotle, Bernstein, Heidegger, Kant, and Gadamer, the result is a hermeneutical approach that pushes beyond the traditional limits of human understanding. This is a bold attempt to move hermeneutics into a new phase. As such, it will be of significant interest to scholars and academics working in General Hermeneutics, Theology, and the Philosophy of Religion. (shrink)

Biological scientists, like scientists in other disciplines, are uncertain about whether or how to use their knowledge and time to provide society with insight and guidance in handling the effects of inventions and discoveries. This article addresses this issue. It presents a typography of structures in which scientists may contribute to social understanding and decisions. It describes the different ways in which these contributions can be made. Finally it develops the ethical arguments that justify the view that biological scientists have (...) social responsibilities. (shrink)

A sentence is never not in a context. We are never not in a situation. A statute is never not read in the light on some purpose. A set of interpretative assumptions is always in force. A sentence that seems to need no interpretation is already the product of one...No sentence is ever apprehended independently of some or other illocutionary force. Illocutionary force is the key term in speech-act theory. It refers to the way an utterance is taken—as an order, (...) a warning, a promise, a proposal, a request, etc.—and the theory's strongest assertion is that no utterance is ever taken purely, that is, without already having been understood as the performance of some illocutionary act. Consider, as an example, the sentence "I will go." Depending on the context in which it is uttered, "I will go" can be understood as a promise, a threat, a warning, a report, a prediction, etc., but it will always be understood as one of these, and it will never be an unsituated kernel of pure semantic value. In other words, "I will go" does not have a basic or primary meaning which is then put to various illocutionary uses; rather, "I will go" is known only in its illocutionary lives, and in each of them its meaning will be different. Moreover, if the meaning of a sentence is a function of its illocutionary force , and if illocutionary force varies with the circumstances, then illocutionary force is not a property of sentences, but of situations. That is, while a sentence will always have an illocutionary force , the illocutionary force it has will not always be the same. Stanley E. Fish is the author of, among many other works, Is There a Text in This Class? Interpretative Authority in the Classroom and in Literary Criticism, and The Living Temple: George Herbert and Catechizing. His contributions to Critical Inquiry include "Facts and Fictions: A Reply to Ralph Rader" , "Interpreting the Variorum" , "Interpreting 'Interpreting the Variorum'" , "A Reply to John Reichert; or, How to Stop Worrying and Learn to Love Interpretation" , and "One More Time". (shrink)

Ralph Rader's model of literary activity is built up from a theory of intention. A literary work, he believes, embodies a "cognitive act,"1 an act variously characterized as a "positive constructive intention" , "an overall creative intention" . To read a literary work is to perform an answering "act of cognition" , which is in effect the comprehension of this comprehensive intention, the assigning to the work of a "single coherent meaning" . Both acts—the embodying and the assigning —are one-time, (...) single-shot performances. They are "ends" in two senses; the overall intention is the end to which everything in the work must be contributory, and its comprehension is something the reader does at the end . Rader offers this model as if it were descriptive, as if it made explicit rules of behavior we unerringly follow, rules which underlie our "tacit or intuitive capacity" of intention producing and intention retrieving; but the model is, in fact, prescriptive since it quite arbitrarily limits this same capacity: authors are limited to no more than one positive constructive intention per unit, while readers or interpreters are limited to its discovery; whatever cannot be related to that discovery or interferes with it will either be declared not to exist or, if its existence cannot be denied, it will be labeled a defect, an "unintended and unavoidable negative consequence of the artist's positive constructive intention" . · 1. My argument will engage two of Rader's articles. They are "Fact, Theory, and Literary Explanation," Critical Inquiry 1, no.2 : 245-72, and "The Concept of Genre and Eighteenth-Century Studies," in New Approaches to Eighteenth-Century Literature: Selected Papers from the English Institute , pp. 79-115. In what follows they will be referred to as Fact and Concept along with the appropriate page number. Stanley E. Fish, professor of English at John Hopkins University, responds in this essay to Ralph W. Rader's "Fact, Theory, and Literary Explanation" . Professor Fish is the author of John Skelton's Poetry, Surprised by Sin: The Reader in Paradise Lost, and Self-Consuming Artifacts: The Experience of Seventeenth-Century Literature. His other contributions to Critical Inquiry include "Interpreting the Variorum" , "CRITICAL RESPONSE: Interpreting 'Interpreting the Variorum'" , "Normal Circumstances, Literal Language, Direct Speech Acts, the Ordinary, the Everyday, the Obvious, What Goes without Saying, and Other Special Cases" , "CRITICAL RESPONSE: A Reply to John Reichert; or, How to Stop Worrying and Learn to Love Interpretation" , and "One More Time". (shrink)