Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals (...) from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

We investigate how nonstandard reals can be established constructively as arbitrary infinite sequences of rationals, following the classical approach due to Schmieden and Laugwitz. In particular, a total standard part map into Richman's generalised Dedekind reals is constructed without countable choice.

LET ME BEGIN this inquiry with the simple but fundamental fact that the flow of time, or passage, as it is also known, is given in experience, that it is as indubitable an aspect of our perception of the world as the sights and sounds that come in upon us, even though it is not the peculiar property of a special sense. Consider, by way of illustration, that I am now sitting at the desk in my study. This particular event (...) was not present at any earlier time, nor will it be present shortly as I become involved in other activities. The present, as I experience it, is regularly associated with later and later events. It does not hop about capriciously from here to a later time, to a previous time, and then to a much later time, or trace out some other such indiscriminate pattern; instead I find it always in association with the next moment, and as I look backward and inward, so to speak, I find that the prior moment was present and that this next-later moment is present. Quite often this condition is expressed by means of imagery. We are asked to envision either a moving present racing along a fixed track of moments or events from earlier to later, or alternatively a fixed present through which stream a series of moments or events, first the earlier and then the later ones. One is in truth hard-pressed to find references to passage which do not employ quasi-poetical tropes and metaphors, and while these do help in some sense to say what we mean, great caution is required when handling them because of their ready tendency to draw us away from the actual phenomenon requiring explanation. (shrink)

Should weak forms of the axiom of choice really be accepted within constructive mathematics? A critical view of the Brouwer-Heyting-Kolmogorov interpretation, accompanied by the intention to include nondeterministic algorithms, leads us to subscribe to Richman's appeal for dropping countable choice. As an alternative interpretation of intuitionistic logic, we propose to renew dialogue semantics.

This book bridges the gaps between logic, mathematics and computer science by delving into the theory of well-quasi orders, also known as wqos. This highly active branch of combinatorics is deeply rooted in and between many fields of mathematics and logic, including proof theory, commutative algebra, braid groups, graph theory, analytic combinatorics, theory of relations, reverse mathematics and subrecursive hierarchies. As a unifying concept for slick finiteness or termination proofs, wqos have been rediscovered in diverse contexts, and proven to be (...) extremely useful in computer science. The book introduces readers to the many facets of, and recent developments in, wqos through chapters contributed by scholars from various fields. As such, it offers a valuable asset for logicians, mathematicians and computer scientists, as well as scholars and students. (shrink)

The long-standing conflict between the two theories centers about the question whether time can exist independently of that which is in it. Those who advocate absolute time answer in the affirmative while the relationists take the opposite position claiming that temporal relations, and thus time, have no reality apart from the things and events which they order. In the terminology of Paul Weiss, relational time is "concrete." The considerable emphasis placed upon this issue of the concreteness of time has adversely (...) affected the absolute theory, leading to presentations of the absolutist position that are confusing, if not erroneous. Absolute time, as interpreted by philosophers such as Broad, Gunn, and Whitehead, posits the existence of abstract moments which are arranged in serial order one before the other by virtue of relations of precedence between them. Things and events participate in time only vicariously, so to speak, being joined to their respective moments by another kind of relation which Whitehead calls "occupation." The overall structure presented by the absolute theory is therefore thought to be as follows: one event is before another if both are respectively bound by relations of occupation to moments which are in turn so related as to be one before the other. Relational time mercifully simplifies this picture by a neat bit of surgery, cutting away the abstract moments and tying the relations of precedence directly to things and events themselves. As a consequence, the parasitic relations of occupation wither away. (shrink)

First it will be necessary to examine the argument, and the meaning of the argument, by which Mr. Ingram-Pearson is led to uphold such an unusual position. Using the statement, "fairies do not exist," as his example, he observes: "In order to achieve its obvious status as a denial this statement must have some object of reference for its subject term; for denials which are denials of nothing are not denials in any sense at all." What, then, is the designate (...) of the term "fairies"? It is, we are told, "an existent [italics mine] which at least one person believes to be present in the world and which another person at the same time and in the same context believes is not there." To say that "fairies do not exist" is therefore to say that "certain entities, designated by the term 'fairies,' are not present in the world," or "specific entities, designated by the term 'fairies,' are really absent from the world." The latter statement is positive, and Mr. Ingram-Pearson tells us explicitly that positive statements cannot "succeed in making intelligible" something made intelligible by negative statements about non-existents; but he has in mind such "ordinary" positive statements as "fairies are imagined beings." In other words, it is not that negative statements about. (shrink)

In this paper I shall examine creation and annihilation in time rather than solipsism of the moment. The argument will focus upon a difficulty raised by the creationist's qualification of the solipsist's denial of past and future. The solipsist maintains that the words "past" and "future" have no object of reference; hence, statements denying their existence, like such statements as "Fairies do not exist" and "Santa Claus does not exist," convey the idea that there simply are no existents to which (...) the subject terms refer. At no point can we accuse the solipsist of making the absurd claim that some existents do not exist, and yet that is precisely the claim which the creationist makes; for his subject term refers to some existent—something which does exist or did exist—and then he denies the existence of that existent. Indeed, he cannot express himself without granting existence, on the one hand, and denying it, on the other, so that he appears at the very outset to be involved in a contradiction. If the following argument is correct, it will prove that the contradiction is not merely apparent but real, and that the creationist is confronted by it as soon as he says what he wants to say in whatever idiom he chooses to say it. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Objective: The establishment of patient-centered measures capable of empirically determining meaningful cognitive change after surgery can significantly improve the medical care of epilepsy patients. Thus, this study aimed to develop reliable change indices (RCIs) and standardized regression-based (SRB) change norms for a comprehensive neuropsychological test battery in the German language. Methods: Forty-seven consecutive patients with temporal lobe epilepsy underwent neuropsychological assessments, both before and 12 months after surgery. Practice-effect-adjusted RCIs and SRB change norms for each test score were computed. To (...) assess their usefulness, the presented methods were applied to a clinical sample, and binary logistic regression analyses were conducted to model the odds of achieving improvement in quality of life (QOL) after surgery. Results: The determined RCIs at 90% confidence intervals, and the SRB equations for each test score included in the test battery are provided. Cohen’s kappa analyses revealed a moderate mean agreement between the two measures, varying from slight to almost perfect agreement across test scores. Using these measures, a negative association between improvement in QOL and decline in verbal memory functions after surgery was detected. Significance: To the best of our knowledge, this study is the first to provide RCIs and SRB change norms necessary for the objective determination of neuropsychological change in a comprehensive test battery in the German language, facilitating the individual monitoring of improvement and decline in each patients’ cognitive functioning and psychosocial situations after epilepsy surgery. The application of the described measures revealed a strong negative association between improvement in QOL and decline in verbal memory functions after surgery. (shrink)

In a fragment entitled Elementa Nova Matheseos Universalis Leibniz writes “the mathesis [...] shall deliver the method through which things that are conceivable can be exactly determined”; in another fragment he takes the mathesis to be “the science of all things that are conceivable.” Leibniz considers all mathematical disciplines as branches of the mathesis and conceives the mathesis as a general science of forms applicable not only to magnitudes but to every object that exists in our imagination, i.e. that is (...) possible at least in principle. As a general science of forms the mathesis investigates possible relations between “arbitrary objects”. It is an abstract theory of combinations and relations among objects whatsoever. In 1810 the mathematician and philosopher Bernard Bolzano published a booklet entitled Contributions to a Better-Grounded Presentation of Mathematics. There is, according to him, a certain objective connection among the truths that are germane to a certain homogeneous field of objects: some truths are the “reasons” of others, and the latter are “consequences” of the former. The reason-consequence relation seems to be the counterpart of causality at the level of a relation between true propositions. Arigorous proof is characterized in this context as a proof that shows the reason of the proposition that is to be proven. Requirements imposed on rigorous proofs seem to anticipate normalization results in current proof theory. The contributors of Mathesis Universalis, Computability and Proof, leading experts in the fields of computer science, mathematics, logic and philosophy, show the evolution of these and related ideas exploring topics in proof theory, computability theory, intuitionistic logic, constructivism and reverse mathematics, delving deeply into a contextual examination of the relationship between mathematical rigor and demands for simplification. (shrink)

This paper explores the possibilities for strategic maneuvering of the argumentative technique that Perelman and Olbrechts-Tyteca (The New Rhetoric. A Treatise on Argumentation, University of Notre Dame Press, Notre Dame/London, 1969) called dissociation. After an exploration of the general possibilities that dissociation may have for enhancing critical reasonableness and rhetorical effectiveness, the use of dissociation in the successive stages of a critical discussion is examined. For each stage, first, the dialectical moves that dissociation can be employed in are specified, then, (...) the specific ways in which dissociation contributes to fulfilling the dialectical tasks that are associated with these moves are delineated, and, finally, the rhetorical gain that␣dissociation can bring in the fulfillment of these tasks is discussed. Some general conclusions are drawn for research that aims at understanding the potential of an argumentative technique for strategic maneuvering. (shrink)

In this article, the pragma-dialectical model of a critical discussion is demonstrated to provide a useful instrument for discovering causes of an unsatisfactory development of problem-solving discussions. First a sketch is given of the development of a problem-solving discussion which, in the opinion of the participants themselves, developed in an unsatisfactory fashion. Then it is argued that this development can be traced back to flaws in the execution of the stages of a critical discussion.

The classical Athenian philosopher Socrates was tried in 399 BCE on the basis of two notoriously ambiguous charges: corrupting the youth and impiety (in Greek, asebeia). A majority of the 501 dikasts (Athenian citizen-jurors) voted to convict him. Socrates was ultimately sentenced to death by drinking a hemlock-based liquid. This well-known account of the trial is by Plato, one of Socrates' students and a famous philosopher in his own right. Whether Socrates was punished unjustly is a contested issue which to (...) this day inspires discussions about the nature and meaning of justice. (shrink)

Objectives: Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study’s objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whether deviating from standard informed consent procedures could be morally justified. Design: A survey among nursing home physicians. Setting & Participants: We sent a questionnaire to all (356) nursing (...) homes in the Netherlands, to be completed by one of the physicians. Results: We received 245 completed questionnaires. As 21 institutions appeared to be closed or merged into other institutions, the response was 73.1% (245/335). Of all respondents 81.9% reported a vaccination rate above 80%. Almost 50% reported a vaccination rate above 90%. Most respondents considered herd immunity to be an important consideration for institutional policy. Freedom of choice for residents was considered important by almost all. Nevertheless, 106 out of 245 respondents follow a tacit consent procedure, according to which vaccination will be administered unless the resident or her proxy refuses. These institutions show significantly higher vaccination rates (p < 0.03). Conclusions: In our discussion we focus on the question whether tacit consent procedures can be morally justifiable. Such procedures assume that vaccination is good for residents either as individuals or as a group. Even though this assumption may be true for most residents, there are good reasons for preferring express consent procedures. (shrink)

In this article, after arguing that present approaches to improving problem-solving discussions for various reasons are not satisfactory, I turn to the pragma-dialectic approach to argumentative discourse to derive a normative framework that can serve as a point of departure to enhance the quality of problem-solving discussions. I then show how this approach can be used as analytical and evaluative instrument that can help the analyst to establish whether participants in actual practice act in a fashion that is in accord (...) with the norms posited. Two real-life problem-solving discussions provide the material for this demonstration. (shrink)

The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research Council’s (...) Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits. (shrink)

This article is dedicated to the issue of achieving consensus in tabletop role-playing games and also addresses the question of how exactly play­ers gain power over the interpretation of events within a tabletop RPG. A tabletop role-playing game presupposes that its participants constantly articulate statements which shift the current configuration of in-game elements and also play the role of being artistic descriptions of said shifts. The alternation and interplay of performative and descriptive statements, their convolution and also the fact that, (...) in tabletop RPGs, unlike in the majority of the rest of the games known to humanity, the same words from natural languages are used both in order to produce a shift in abstract, symbolic structure of a game, and to artistically describe said shift, all lead to the situation where participants cannot tell a proper symbolic system of a given game from other symbolic systems which this game refers to. In this article, we propose an analytical model of a tabletop RPG which would make it possible to draw stricter borderlines between a given RPG’s fictional world and its inner symbolic structure. Furthermore, it would allow us to formulate a clearer question regarding the structures of power produced while playing an RPG, and what exactly players gain control over while playing it. Moreover, this model would enable us to explore in detail the processes of the individual and collective interpretation of events in a tabletop RPG, and classify facts within said interpretation in relation to whether they are held to be objectively or subjectively true. (shrink)

The expertise defense is the best-known response by armchair philosophers to the challenge posed by experimental philosophers regarding the trustworthiness of intuitions. In a series of recent experiments, Experimental philosophers have recently focused on professional philosophers, claiming that, contrary to what the expertise defense assumes, philosophers’ intuitions are no less susceptible to the influence of irrelevant factors (the direct strategy). Additionally, drawing from literature on expertise, they contend that, unlike other domains of expertise, practice does not improve philosophers’ intuitions (the (...) indirect strategy). In this paper, adopting a skill-based perspective on expertise, my primary objective is to defend the expertise defense against both direct and indirect strategies. Based on the skill-based account, I present three arguments against the direct strategy by challenging its power, scope and methodology. Furthermore, borrowing empirical findings from recent literature on expertise, I argue against the indirect strategy that four skills that constitute philosophical expertise regarding thought experiments can be improved through various forms of practice, including deliberate practice. However, my moderate defense departs from typical versions of the expertise defense since I argue that while recent experiments by experimental philosophers cannot undermine the expertise defense, they provide valuable insights into philosophical expertise. (shrink)

In Chinese scholarship, Xunzi is often regarded as an eclectic Confucian master who accepted some form of utilitarian thoughts (e.g. Fung Yu-lan, Mou Zongsan and Xu Fuguan). This characteristic was also observed by some western scholars such as Benjamin I. Schwartz. In a recent study, I argued that the basic character of Xunzi’s philosophy is utilitarianism in a broad sense based on an examination on his intellectual criticism and political criticism. Xunzi asserts that humans are innately driven by self-interested desires, (...) and he evaluates all intellectual works and political behaviours by their utility. However, he does not limit utility to only basic animal desires such as food and sex. In Xunzi’s view, humans also have innate emotions; hence, these emotions should also be accounted for in their utility. This is similar to John Stuart Mill’s redefinition of Bentham’s concept of utility. Are Xunzi’s and Mill’s concepts of utility exactly the same? This question has yet to be examined. This article is a comparative study between utilitarianism and Xunzi’s philosophy which especially explores the compatibility of these two philosophies. (shrink)

The vast majority of contributions to the literature on spirituality in nursing make extravagant claims about transcendence, eternity, the numinous, higher powers, higher levels of existence, invisible forces, cosmic unity, the essence of humanity, or other supernatural concepts. Typically, these assertions are made without the support of argument or evidence; and, as a consequence, alternative ways of theorizing ‘spirituality’ have been closed off, while the lack of consistent scholarship has turned the topic into a metaphysical backwater. In this paper, I (...) adopt a different premise, rejecting unsupported claims, and surveying the ‘spirituality’ terrain from a naturalistic and reductionist perspective. I argue that, if we rid ourselves of non‐naturalistic assumptions, we will discover theoretical and clinical resources in health psychology, social psychology, neuropsychology, and pharmacopsychology – resources which confirm that it is possible to conceptualize the study of existential concerns, and how health professionals might respond to them, in a properly scientific manner. In order to illustrate the potential usefulness of these resources, I will take palliative care as an example. (shrink)

What is the relationship between consciousness and our brain? Are they one and the same? Who are we really? The Consciousness Network presents a novel account of one of the greatest scientific challenges of the 21st century: understanding the connection between brain and mind. The book explores remarkable cases of patients who demonstrate how our impression of reality is created by the brain. Age-old questions about dreams, colour perception, phantom sensations and hallucinations are illuminated by surprising discoveries from the latest (...) brain research. How does consciousness differ from memory, emotions and behaviour? How did it develop during the evolution of life on earth, and does it serve a purpose? Does the brain leave room for free will? In this unique blend of philosophy, history, psychology and neuroscience, Cyriel Pennartz breaks new ground by presenting an original theory of brain and mind, substantiated by brain research in patients and healthy people. This theory, inspired by the 17th century philosopher Spinoza, goes significantly deeper than current thinking based on computer models or artificial intelligence. The Consciousness Network is essential reading for students working at the interface of neuroscience, cognitive psychology, philosophy of mind and cognitive science, as well as anyone interested in consciousness and the brain. (shrink)