This article examines five different Medical-Legal Partnerships associated with Yale Law School in New Haven, Connecticut to illustrate how MLP addresses the social determinants of poor health. These MLPs address varied and distinct health and legal needs of unique patient populations, including: 1) children; 2) immigrants; 3) formerly incarcerated individuals; 4) patients with cancer in palliative care; and 5) veterans. The article charts a research agenda to create the evidence base for quality and evaluation metrics, capacity building, sustainability, and best (...) practices; it also focuses specifically on a research agenda that identifies the value of the lawyers in MLP. Such a focus on the “L” has been lacking and is overdue. (shrink)

Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

This paper sheds light on the role of digital platform labour in the development of today’s artificial intelligence, predicated on data-intensive machine learning algorithms. Focus is on the specific ways in which outsourcing of data tasks to myriad ‘micro-workers’, recruited and managed through specialized platforms, powers virtual assistants, self-driving vehicles and connected objects. Using qualitative data from multiple sources, we show that micro-work performs a variety of functions, between three poles that we label, respectively, ‘artificial intelligence preparation’, ‘artificial intelligence verification’ (...) and ‘artificial intelligence impersonation’. Because of the wide scope of application of micro-work, it is a structural component of contemporary artificial intelligence production processes – not an ephemeral form of support that may vanish once the technology reaches maturity stage. Through the lens of micro-work, we prefigure the policy implications of a future in which data technologies do not replace human workforce but imply its marginalization and precariousness. (shrink)

The spacing effect is among the most widely replicated empirical phenomena in the learning sciences, and its relevance to education and training is readily apparent. Yet successful applications of spacing effect research to education and training is rare. Computational modeling can provide the crucial link between a century of accumulated experimental data on the spacing effect and the emerging interest in using that research to enable adaptive instruction. In this paper, we review relevant literature and identify 10 criteria for rigorously (...) evaluating computational models of the spacing effect. Five relate to evaluating the theoretic adequacy of a model, and five relate to evaluating its application potential. We use these criteria to evaluate a novel computational model of the spacing effect called the Predictive Performance Equation. Predictive Performance Equation combines elements of earlier models of learning and memory including the General Performance Equation, Adaptive Control of Thought—Rational, and the New Theory of Disuse, giving rise to a novel computational account of the spacing effect that performs favorably across the complete sets of theoretic and applied criteria. We implemented two other previously published computational models of the spacing effect and compare them to PPE using the theoretic and applied criteria as guides. (shrink)

To function well in an unpredictable environment using unreliable components, a system must have a high degree of robustness. Robustness is fundamental to biological systems and is an objective in the design of engineered systems such as airplane engines and buildings. Cognitive systems, like biological and engineered systems, exist within variable environments. This raises the question, how do cognitive systems achieve similarly high degrees of robustness? The aim of this study was to identify a set of mechanisms that enhance robustness (...) in cognitive systems. We identify three mechanisms that enhance robustness in biological and engineered systems: system control, redundancy, and adaptability. After surveying the psychological literature for evidence of these mechanisms, we provide simulations illustrating how each contributes to robust cognition in a different psychological domain: psychomotor vigilance, semantic memory, and strategy selection. These simulations highlight features of a mathematical approach for quantifying robustness, and they provide concrete examples of mechanisms for robust cognition. (shrink)

The purpose of this paper is to describe the nature of dental practice and to identify some recent innovations which have effect on cost containment in dentistry. The first of these innovations is dental insurance or prepaid dental services. Dental insurance has only recently emerged as a significant economic factor. The chronic and prevalent nature of dental disease mandates that the management of these programs incorporate insurance devices which limit demand and utilization. These devices amount to cost containment measures. The (...) second factor to be discussed is advertising. Advertising has been foisted on the dental profession by recent rulings of the Federal Trade Commission in an effort to promote competition. The Reagan administration, despite a market oriented approach to health care, had attempted to blunt some of the FTC actions. Advertising, nevertheless, has the potential to stimulate competition and restrain price escalation. The third factor includes a discussion of alternative delivery systems. These commercially oriented dental enterprises have the potential to compete with established practices as well as increase the demand for services. (shrink)

The increasing complexity of human subjects research and its oversight has prompted researchers, as well as institutional review boards, to have a forum in which to discuss challenging or novel ethical issues not fully addressed by regulations. Research ethics consultation services provide such a forum. In this article, we rely on the experiences of a national Research Ethics Consultation Collaborative that collected more than 350 research ethics consultations in a repository and published 18 challenging cases with accompanying ethical commentaries to (...) highlight four contexts in which REC can be a valuable resource. REC assists: 1) investigators before and after the regulatory review; 2) investigators, IRBs, and other research administrators facing challenging and novel ethical issues; 3) IRBs and investigators with the increasing challenges of informed consent and risk/benefit analysis; and 4) in providing flexible and collaborative assistance to overcome study hurdles, mediate conflicts within a team, or directly engage with research participants. Institutions that have established, or plan to establish, REC services should work to raise the visibility of their service and engage in open communication with existing clinical ethics consult services as well as the IRB. While the IRB system remains the foundation for the ethical review of research, REC can be a valuable service for investigators, regulators, and research participants aligned with the goal of supporting ethical research. (shrink)

The aim of J.-L. Marion’s article is to revisit the important debate on the place of Augustine in the history of metaphysics. Often, quibbles arise upon considering the use of substance (substantia) by Augustine, not only as approximative of essentia and as synonymous with ousia, but in deciding whether in so doing Augustine effectuates a ‘metaphysical turn’. While he elsewhere argues that Augustine is a pre-metaphysical thinker, in this article Marion focuses on showing the diverse range of usages (...) of the term substance in the Augustinian corpus. Marion observes: first, whenever substance seems a fixed definition, the term allows for equivocity; second, God is substance in an indeterminate sense or by negation; third, human beings are substances fundamentally to capture the mutability of human existence. As such, Marion concludes, the Augustinian use of substance is insufficient to inelude Augustine in the history of metaphysics. (shrink)

The required professional and ethical pronouncements of accountants mean that auditors need to be competent and exercise due care and skill in the performance of their audits. In this study, we examine what happens when auditors take on more clients than they should, thus raising doubts about their ability to maintain competence and audit quality. Using 2803 observations of Malaysian companies from 2010 to 2013, we find that auditors with multiple clients are associated with lower earnings quality, proxied by total (...) accruals and discretionary accruals. Our results demonstrate that associating client firms’ reported discretionary accruals with individual auditors, rather than their firms or offices, is important in determining audit quality. Moreover, we demonstrate that the disclosure of auditors’ signatures on their reports is useful for assessing auditor quality at the individual level, thus contributing to the debate on the usefulness of having auditor identities on reports. (shrink)

One of the most striking findings of the study by Foglia and colleagues (2009) was that clinicians and managers were most concerned with limited resources while ethics committee chairpersons focuse...

Although rationing by clinical judgment is controversial, its acceptability partly depends on how it is practiced. In this paper, rationing by clinical judgment is defined in three different circumstances that represent increasingly wider circles of resource pools in which the rationing decision takes place: triage during acute shortage, comparison to other potential patients in a context of limited but not immediately strained resources, and determination of whether expected benefit of an intervention is deemed sufficient to warrant its cost by reference (...) to published population based thresholds. Notions of procedural justice are applied along with an analytical framework of six minimal requisites in order to facilitate fair bedside rationing: (1) a closed system that offers reciprocity, (2) attention to general concerns of justice, (3) respect for individual variations, (4) application of a consistent process, (5) explicitness, and (6) review of decisions. The process could be monitored for its applicability and appropriateness. (shrink)

Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.

Clinical ethics support services are developing in Europe. They will be most useful if they are designed to match the ethical concerns of clinicians. We conducted a cross-sectional mailed survey on random samples of general physicians in Norway, Switzerland, Italy, and the UK, to assess their access to different types of ethics support services, and to describe what makes them more likely to have used available ethics support. Respondents reported access to formal ethics support services such as clinical ethics committees (...) (23%), consultation in individual cases (17.6%), and individual ethicists (8.8%), but also to other kinds of less formal ethics support (23.6%). Access to formal ethics support services was associated with work in urban hospitals. Informal ethics resources were more evenly distributed. Although most respondents (81%) reported that they would find help useful in facing ethical difficulties, they reported having used the available services infrequently (14%). Physicians with greater confidence in their knowledge of ethics (P = 0.001), or who had had ethics courses in medical school (P = 0.006), were more likely to have used available services. Access to help in facing ethical difficulties among general physicians in the surveyed countries is provided by a mix of official ethics support services and other resources. Developing ethics support services may benefit from integration of informal services. Development of ethics education in medical school curricula could lead to improved physicians sensititity to ethical difficulties and greater use of ethics support services. Such support services may also need to be more proactive in making their help available. (shrink)

Examines the relationship between the question of God and the destiny of metaphysics. Concept of the end of metaphysics; Ambiguous relation between phenomenology and metaphysics; Return of special metaphysics in phenomenology; Phenomenological figure of God. Examines the relationship between the question of God and the destiny of metaphysics. Concept of the end of metaphysics; Ambiguous relation between phenomenology and metaphysics; Return of special metaphysics in phenomenology; Phenomenological figure of God.

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

The domain of children's social understanding, including understanding of one's own and others’ minds and emotions, has been the topic of much research over the past few decades. Social understandi...

In lieu of an abstract, here is a brief excerpt of the content:FDA Releases Draft Guidance on Regulation of Genetically Engineered AnimalsJohn P. Gluck (bio) and Mark T. Holdsworth (bio)On 18 September 2008, the U.S. Food and Drug Administration (FDA) issued a draft set of guidelines for those involved in developing genetically engineered animals with heritable recombinant DNA (rDNA) constructs and is requesting comment from industry and the public about their content. The document does not impose new regulations but (...) details how existing laws and regulations apply to genetically engineered (GE) animals and offers advice to developers on how to negotiate the laws in the most efficient and productive manner. The draft guidance document is not legally enforceable at this juncture, but the guidelines are recommendations reflecting the FDA's "current thinking on a topic."The modification of GE animals being developed for commercialization, which are the focus of the document, fall into six categories: modifications intended to (1) enhance food quality—e.g., faster growing fish and meats with better nutritional profiles; (2) improve animal health via increased resistance to disease—e.g., mastitis in dairy cattle and Bovine Spongiform Encephalopathy (BSE); (3) create so-called "biopharm" animals capable of producing therapeutic products such as insulin, clotting factors, and tissues for human transplantation; (4) reduce the barriers to human animal interaction—e.g., hypoallergenic pets; (5) develop valid animal models of human disease—e.g., Parkinson's disease, Lesh-Nyhan's syndrome, and cancer; and (6) improve production of industrial or consumer products such as fiber. The timing of the guidelines coincides with the FDA's belief in an expected boon in the number of GE animals approaching the stage of commercialization.The FDA's involvement in the approval process emerges from the new animal drug provisions of the Federal Food Drug and Cosmetic Act and the definition of what constitutes a drug. The Act defines a new animal drug as "an article (other than food) intended to affect the structure or any function of the body of... animals." A rDNA construct intended to affect the structure or function of an animal meets the definition of a new animal drug, regardless of whether the resulting GE animals are intended for human food or the production of pharmaceuticals or any other substances. [End Page 393]Before proceeding to a review of the draft guidelines, it is important briefly to set the controversies around GE animals in historical and ethical context.The Ethical DebateFrom its inception, the intentional genetic modification or genetic engineering of molecules, plants, and animals by the techniques of gene splicing has consistently elicited strong responses from both the scientific community and the public. There are some data to suggest that although the concerns of scientists fall primarily into the category of possible biohazards, those of the public also reflect great concern about the intrinsic moral issues, such as whether there is something fundamentally wrong with this line of work, making it a form of forbidden knowledge (see, e.g., Gaskell 1997). When news of Paul Berg's attempts in 1970 to graft the primate tumor virus (SV 40) onto the intestinal tract bacteria Escherichia coli for the purpose of studying how normal cells may be transformed into cancerous cells was shared with colleagues, he was strongly encouraged to reflect on the potential public health risks if somehow the altered bacteria broke containment and entered the environment. Thanks to Berg's leadership, these concerns soon resulted in conferences held in Asilomar, California, and New Hampton, New Hampshire, where the ethical responsibilities of microbiologists involved in this research were discussed. These initial discussions resulted in what has come to be known as "The Moratorium Letter" (Shattuck 1996) published in the journal Science in 1974. This letter, signed by 11 leaders in the field, actually recommended restrictions on several types of experiments that were considered to be particularly risky and stated "that adherence to our major recommendations will entail postponement or possibly abandonment of certain types of scientifically worthwhile experiments" (Berg 1974). An international conference on the issues came to similar conclusions about the need for a research moratorium for the sake of public safety. Recommendations arising from conference participants led to the formation of the National Institutes... (shrink)

Is there anything that members of each binary category of gender have in common? Even many non-essentialists find the lack of unity within a gender worrying as it undermines the basis for a common political agenda for women. One promising proposal for achieving unity is by means of a shared historical lineage of cultural reproduction with past binary models of gender. I demonstrate how such an account is likely to take on board different binary and also non-binary systems of gender. (...) This implies that all individuals construed as members of the category, “women” are in fact not members of the same historical kind after all! I then consider different possible means of modifying the account but conclude negatively: the problem runs deeper than has been appreciated thus far. (shrink)

As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do not lose (...) the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

Natural kinds is a widely used and pivotal concept in philosophy – the idea being that the classifications and taxonomies employed by science correspond to the real kinds in nature. Natural kinds are often opposed to the idea of kinds in the human and social sciences, which are typically seen as social constructions, characterised by changing norms and resisting scientific reduction. Yet human beings are also a subject of scientific study.Does this mean humans fall into corresponding kinds of their own? (...) In The Epistemology and Morality of Human Kinds Marion Godman defends the idea of human kinds. She first examines the scientific use and nature of human kinds, considering the arguments of key philosophers whose work bears upon human kinds, such as Ian Hacking, John Searle, Richard Boyd and Ruth Millikan. Using the examples of gender, ethnic minorities and Buddhism she then argues that human kinds are a result of ongoing historical reproduction, chiefly due to pre-existing cultural models and social learning. Her novel argument shifts the focus away from the reductionism characteristic of research about human kinds. Instead, she argues that they are “multiply projectable” and deserving of scientific study not in spite of, but because of their role in explaining our identity, injustice and the emergence of group rights. (shrink)

This article attempts to analyse the ongoing debate regarding open-mindedness as an educational value. The views of Hare, McLaughlin and Gardner are considered. They do not always agree on what open-mindedness is, and the discussion could benefit from a more unified terminology and better counter-examples. The value and limitations of open-mindedness in both science and the humanities are discussed and analysed. It is argued that open-mindedness, while clearly a virtue if not taken to excess, need not be a goal of (...) the educational process. (shrink)

This article attempts to analyse the ongoing debate regarding open-mindedness as an educational value. The views of Hare, McLaughlin and Gardner are considered. They do not always agree on what open-mindedness is, and the discussion could benefit from a more unified terminology and better counter-examples. The value and limitations of open-mindedness in both science and the humanities are discussed and analysed. It is argued that open-mindedness, while clearly a virtue if not taken to excess, need not be a goal of (...) the educational process. (shrink)

Events in the US in 2020 have laid bare the reality that racism and its effects continue to take a heavy toll on the lives of Black Americans. The three articles in this issue of AJOB each provide...

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

Reconstructing Popper's research programme for the Human Sciences, Noretta Koertge (Inquiry, Vol. 18 [1975]) has given a deductive?nomological account of explanations of actions by means of a Rationality Principle. It is argued here that such a Rationality Principle is fundamentally redundant. Neither is it logically necessary in order to deduce a cognitive action?explanandum, nor can it be given a semantic non?empty interpretation, at least not within Koertge's own syllogism. Any attempt to save the Rationality Principle as unfalsifiablc but nevertheless indispensable (...) for action explanations is rejected in the light of possible alternative action explanations by empirical and therefore in principle falsifiable psychological laws. (shrink)

A long history of research has revealed many neurophysiological changes and concomitant behavioral impacts of sleep deprivation, sleep restriction, and circadian rhythms. Little research, however, has been conducted in the area of computational cognitive modeling to understand the information processing mechanisms through which neurobehavioral factors operate to produce degradations in human performance. Our approach to understanding this relationship is to link predictions of overall cognitive functioning, or alertness, from existing biomathematical models to information processing parameters in a cognitive architecture, leveraging (...) the strengths from each to develop a more comprehensive explanation. The integration of these methodologies is used to account for changes in human performance on a sustained attention task across 88 h of total sleep deprivation. The integrated model captures changes due to time awake and circadian rhythms, and it also provides an account for underlying changes in the cognitive processes that give rise to those effects. The results show the potential for developing mechanistic accounts of how fatigue impacts cognition, and they illustrate the increased explanatory power that is possible by combining theoretical insights from multiple methodologies. (shrink)

According to sources both in print and at a recent meeting, evolutionary theory is currently undergoing change which some would characterize as a New Synthesis, and others as an Extended Synthesis. This article argues that the important changes involve recognizing that there are three means by which evolutionary change can be initiated and three corresponding modes of evolutionary drift. It compares the three and goes on to discuss the scale of innovation and extended or inclusive and Lamarckian inheritance. It concludes (...) from these that “new trends in evolutionary biology” are in part a new, and in part an extended evolutionary synthesis. (shrink)

Maimonides real opinion regarding it. Then, as now, the Aristotelian theory of an eternal material universe seemed more plausible to many people than did the Biblical view of creation exnihilo. While creation is the orthodox view in both Judaism and Christianity, the tension between those two explanatory models goes back a long way. 1 Referring to the heretical views of Elisha ben Abuya, in the early Talmudic period, David Hartman argues as follows.

Upon what kind of moral order does capitalism rest? Conversely, does the market give rise to a distinctive set of beliefs, habits, and social bonds? These questions are certainly as old as social science itself. In this review, we evaluate how today's scholarship approaches the relationship between markets and the moral order. We begin with Hirschman's characterization of the three rival views of the market as civilizing, destructive, or feeble in its effects on society. We review recent work at the (...) intersection of sociology, economics, and political economy and show that these views persist both as theories of market society and moral arguments about it. We then argue that a fourth view, which we call moralized markets, has become increasingly prominent in economic sociology. This line of research sees markets as cultural phenomena and moral projects in their own right, and seeks to study the mechanisms and techniques by which such projects are realized in practice. (shrink)