Background and aim With the increasing interest in lifestyle, health and consequences of unhealthy lifestyles for the healthcare system, a new kind of solidarity is gaining importance: lifestyle solidarity. While it might not seem fair to let other people pay for the costs arising from an unhealthy lifestyle, it does not seem fair either to punish people for their lifestyle. However, it is not clear how solidarity is assessed by people, when considering disease risks or lifestyle risks. The aim of (...) this study was to investigate the degree of solidarity with lifestyle as well as with other factors that are related to health outcomes—for example, old age—and the relation between this degree of solidarity and various characteristics. Methods This cross-sectional study is part of the Dutch longitudinal SMILE study. Data on the degree of solidarity with different lifestyles and old age, and the relation between the degree of solidarity and various demographic and other variables were obtained in a questionnaire survey. Results Solidarity with smokers and overweight people was moderate, as was solidarity with older people. Respondents were ambivalent about athletes. Respondents who were younger, male and highly educated, and those with a healthy lifestyle, a small social network, high quality of life and an internal locus of control, showed low solidarity. Conclusions Solidarity with an unhealthy lifestyle and old age is moderate and the degree of solidarity varies among the different subgroups. (shrink)

Lee and Schwarz interpret meta-analytic research and replication studies as providing evidence for the robustness of cleansing effects. We argue that the currently available evidence is unconvincing because publication bias and the opportunistic use of researcher degrees of freedom appear to have inflated meta-analytic effect size estimates, and preregistered replications failed to find any evidence of cleansing effects.

ObjectiveInformed consent is a prerequisite for caesarean section, the commonest surgical procedure in low- and middle-income settings, but not always acquired to an appropriate extent. Exploring perceptions of health care workers may aid in improving clinical practice around informed consent. We aim to explore health workers’ beliefs and experiences related to principles and practice of informed consent.MethodsQualitative study conducted between January and June 2018 in a rural 150-bed mission hospital in Southern Malawi. Clinical observations, semi-structured interviews and a focus group (...) discussion were used to collect data. Participants were 22 clinical officers, nurse-midwives and midwifery students involved in maternity care. Data were analysed to identify themes and construct an analytical framework.ResultsDefinition and purpose of informed consent revolved around providing information, respecting women’s autonomy and achieving legal protection. Due to fear of blame and litigation, health workers preferred written consent. Written consent requires active participation by the consenting individual and was perceived to transfer liability to that person. A woman’s refusal to provide written informed consent may pose a dilemma for the health worker between doing good and respecting autonomy. To prevent such refusal, health workers said to only partially disclose surgical risks in order to minimize women's anxiety. Commonly perceived barriers to obtain a fully informed consent were labour pains, language barriers, women’s lack of education and their dependency on others to make decisions.ConclusionsHealth workers are familiar with the principles around informed consent and aware of its advantages, but fear of blame and litigation, partial disclosure of risks and barriers to communication hamper the process of obtaining informed consent. Findings can be used to develop interventions to improve the informed consent process. (shrink)

This essay takes Arthur Danto’s end-of-art thesis as a case in point of a substantive philosophy of history. Such philosophy explains the direction that art has taken and why that direction could not have been different. Danto never scrutinized the philosophy of history that his end-of-art thesis presumes. I aim to do that by drawing a distinction between what I refer to as the common view of history and the philosophical view of history, and by arguing that we need the (...) latter if we want to properly assess the plausibility of the end-of-art thesis. (shrink)

The “exemplification theory of history” is proposed to account for the relationship between the past and historical narratives. The theory states that what belongs to the past according to some narrative does so in order to exemplify the historical thesis of that narrative. As such the theory explains how the past receives its meaning. This implies that the past has no intrinsic historical meaning itself. Moreover, it follows that historical narratives possess an autonomy of their own with regard to the (...) past. It is argued that the exemplification theory of history goes to the heart of narrativist philosophy of history. This claim is supported by the key arguments of three narrativist philosophers: Arthur Danto, Louis Mink and Frank Ankersmit. The distinction between the history of social individuals and the identification of such individuals turns out to be fundamental in this respect. The article concludes by distinguishing between a Platonic and an Aristotelian view on narrative and by explaining why we ought to prefer the former to the latter. (shrink)

An important artistic topic of Italian Renaissance painting was the rendering of the human figure. As leading actors in a painted narrative, figures had to convince beholders of the reality of the matter depicted with appropriated attitudes and gestures. This article is about two ways of drawing or rather constructing the human figure artists developed to achieve this goal. The first was only an adaptation to an old method: because of the rather simple and coarse elements used, constructions often resulted (...) in faulty pictures and were for that matter often criticized. As this article will show, the second method involved a new and very successful drawing skill, which not just required a different kind of knowledge of visual forms but of procedures of moving the hand, too. (shrink)

The problem how to ascertain the truth about the past is as old as history itself. But until the work of Louis Mink, no clear distinction was made between questions concerning the truth of statements on the past and questions concerning the truth of historical narratives as a whole. A narrative, Mink argues, is not simply a conjunction of statements on the past. Therefore its truth cannot be a function of the truth of its individual statements. The problem of narrative (...) truth is according to him thus: although each statement asserting a relation between events is subject to confirmation and disconfirmation, the combination of interrelations as established by the historical narrative is not, even though such combination of interrelations represents a real combination in past reality and is claimed to be true. As if to further complicate the problem, Mink maintains that history shares its form with fiction. Three and a half decades after Mink formulated the problem of narrative truth, it has not been dealt with in a satisfying manner. Mink does not solve nor dissolve the problem he posed. That task is taken up in this essay. It will move us away from the vocabulary of literary theory towards a pragmatist account of narrative truth. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator. The respondents were asked (...) to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% completed the questionnaire. One-third of the neurology residents and 21% of the neurologists reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists and neurology residents obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

A theory of the joint measurement of quantum mechanical observables is generalized in order to make it applicable to the measurement of the local observables of field theory. Subsequently, the property of local commutativity, which is usually introduced as a postulate, is derived by means of the theory of measurement from a requirement of mutual nondisturbance, which, for local observables performed at a spacelike distance from each other, is interpreted as a requirement of macrocausality. Alternative attempts at establishing a deductive (...) relationship between relativistic causality and local commutativity are reviewed, but found wanting, either because of the assumption of an unwarranted objectivity of the object system (algebraic approach) or because of the use of a projection postulate (operational approach). Finally, the quantum mechanical nonobjectivity is related to certain features of nonlocality which are present in the formalism of quantum mechanics. (shrink)

BackgroundWith advances in sequencing technologies, increasing numbers of people are being informed about a genetic disease identified in their family. In current practice, probands are asked to inform at-risk relatives about the diagnosis. However, previous research has shown that relatives are sometimes not informed due to barriers such as family conflicts. Research on family communication in genetic diseases aims to explore the difficulties encountered in informing relatives and to identify ways to support probands in this.Main bodyResearch on family communication may (...) also reveal that participants did not inform their relatives about the risk of a serious genetic condition, even when preventive and treatment options are available. Researchers may then face a dilemma: Do they need to warn at-risk relatives about the finding? Or do they keep silent due to prior confidentiality agreements with study participants?ConclusionsWe believe that the absolute confidence promised to research participants outweighs the interests of their relatives, even though it can be claimed that relatives at risk of a genetic disease do, in principle, have a right to know information collected about their health. Not respecting confidentiality agreements could cause distrust between researchers and research participants and possibly harm the relationship between probands and relatives. Relatives' health interests can still be taken into account without jeopardizing participant trust, by considering alternative scenarios, including sharing general study findings on the barriers participants experience with their healthcare professionals and by offering participants psychosocial support for family communication. (shrink)

Wiljan van den Akker is a university professor, a respected academic administrator, and a published poet and writer. From a base at the Utrecht University, in the Netherlands, his three-decade long career spans three continents and includes one-on-one associations with Berkeley, UCLA and Oxford. Currently, he is the Vice-Rector for Research at Utrecht but retains the title he was awarded in 2003, Distinguished Professor of Modern Poetry. In early June 2015, Peter Vale interviewed van den Akker in his (...) house in Jeruzalemstraat, Utrecht. This is an edited version of two conversations. (shrink)

Within current debates about the future impact of Artificial Intelligence on human society, roughly three different perspectives can be recognised: the technology-centric perspective, claiming that AI will soon outperform humankind in all areas, and that the primary threat for humankind is superintelligence; the human-centric perspective, claiming that humans will always remain superior to AI when it comes to social and societal aspects, and that the main threat of AI is that humankind’s social nature is overlooked in technological designs; and the (...) collective intelligence-centric perspective, claiming that true intelligence lies in the collective of intelligent agents, both human and artificial, and that the main threat for humankind is that technological designs create problems at the collective, systemic level that are hard to oversee and control. The current paper offers the following contributions: a clear description for each of the three perspectives, along with their history and background; an analysis and interpretation of current applications of AI in human society according to each of the three perspectives, thereby disentangling miscommunication in the debate concerning threats of AI; and a new integrated and comprehensive research design framework that addresses all aspects of the above three perspectives, and includes principles that support developers to reflect and anticipate upon potential effects of AI in society. (shrink)

Vaccination programmes against infectious diseases aim to protect individuals from serious illness but also offer collective protection once a sufficient number of people have been immunized. This so-called ‘herd immunity’ is important for individuals who, for health reasons, cannot be immunized or who respond less well to vaccines. For these individuals, it is pivotal that others establish group protection. However, herd immunity can be compromised when people deliberately decide not to be immunized and benefit from the herd’s protection. These agents (...) are often referred to as free riders: their omissions are deemed to be unfair to those who do contribute to the collective’s health. This article addresses the unfairness of such ‘free riding’. An argument by Garett Cullity is examined, which asserts that the unfairness of moral free riding lies neither in one’s intentions, nor in one’s reluctance to embrace a public good. This argument offers a strong basis for justifiably arguing that free riding is unfair. However, it is then argued that other considerations also need to be taken into account before simply holding free riding against non-compliers. (shrink)

On a few occasions F.A. Hayek made reference to the famous Gödel theorems in mathematical logic in the context of expounding his cognitive and social theory. The exact meaning of the supposed relationship between Gödel's theorems and the essential proposition of Hayek's theory of mind remains subject to interpretation, however. The author of this article argues that the relationship between Hayek's thesis that the human brain can never fully explain itself and the essential insight provided by Gödel's theorems in mathematical (...) logic has the character of an analogy, or a metaphor. Furthermore the anti-mechanistic interpretation of Hayek's theory of mind is revealed as highly questionable. Implications for the Socialist Calculation Debate are highlighted. It is in particular concluded that Hayek's arguments for methodological dualism, when compared with those of Ludwig von Mises, actually amount to a strengthening of the case for methodological dualism. (shrink)

Background: Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries.Methods: A standardized 32 h dance protocol (...) introduced a range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women participated in the study who had a breast cancer diagnosis 6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life. T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention.Results: Statistically significant changes were found for: weight, right and left forearm circumference and hip; 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large.Conclusion: Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research. (shrink)