Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here (...) we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients. (shrink)

Inductive reasoning is fundamental to human cognition, yet it remains unclear how we develop this ability and what might influence our inductive choices. We created novel categories in which crucial factors such as domain and category structure were manipulated orthogonally. We trained 403 4–9-year-old children to categorise well-matched natural kind and artefact stimuli with either featural or relational category structure, followed by induction tasks. This wide age range allowed for the first full exploration of the developmental trajectory of inductive reasoning (...) in both domains. We found a gradual transition from perceptual to categorical induction with age. This pattern was stable across domains, but interestingly, children showed a category bias one year later for relational categories. We hypothesise that the ability to use category information in inductive reasoning develops gradually, but is delayed when children need to process and apply more complex category structures. (shrink)

Recent data indicate that under a specific posthypnotic suggestion to circumvent reading, highly suggestible subjects successfully eliminated the Stroop interference effect. The present study examined whether an optical explanation could account for this finding. Using cyclopentolate hydrochloride eye drops to pharmacologically prevent visual accommodation in all subjects, behavioral Stroop data were collected from six highly hypnotizables and six less suggestibles using an optical setup that guaranteed either sharply focused or blurred vision. The highly suggestibles performed the Stroop task when naturally (...) vigilant, under posthypnotic suggestion not to read, and while visually blurred; the less suggestibles ran naturally vigilant, while looking away, and while visually blurred. Although visual accommodation was precluded for all subjects, posthypnotic suggestion effectively eliminated Stroop interference and was comparable to looking away in controls. These data strengthen the view that Stroop interference is neither robust nor inevitable and support the hypothesis that posthypnotic suggestion may exert a top-down influence on neural processing. (shrink)

ImportancePrevious studies of post-acute COVID-19 syndrome have focused on critical cases with severe disease. However, most cases are mild to moderate in disease severity.ObjectiveWe aimed to examine cognitive outcomes in cases of non-critical, mild-to-moderate COVID-19. Design, Setting, and Participants: In this cross-sectional study, we enrolled 72 adults aged 22 to 65 years in Central Texas who had non-critical, mild-to-moderate COVID-19 infection between 13 January 2021 and 20 April 2021.Main Outcomes and MeasuresWe remotely administered cognitive-behavioral testing to determine the frequency of (...) cognitive impairment and examine demographic, clinical, and psychosocial contributors to impairment.ResultsThe frequency of objective cognitive impairment was 40%. The largest number of participants showed impairment on a measure of executive functioning. Attention and processing speed was more impaired in males. Males endorsed lower adherence to social distancing guidelines, which was in turn associated with cognitive impairment across participants. Younger age was correlated with impairment but was also associated with racial/ethnic minority status and increased psychological symptoms. Moderate COVID-19 severity was associated with attention/processing speed impairment, increased pain, and higher number of COVID-19 symptoms.Conclusion and RelevanceMild or moderate COVID-19 infection may be associated with cognitive impairments, especially in the domain of executive functioning. A subgroup of younger individuals may be more vulnerable to cognitive and psychosocial effects of COVID-19.HighlightsQuestion: How frequent is cognitive impairment among non-critical, mild-to-moderate COVID-19 survivors?FindingsIn this cross-sectional study of 72 adults, 40% demonstrated cognitive impairment, particularly in executive function.MeaningNeurologic sequelae, such as cognitive impairment, may be common following COVID-19 infection. (shrink)

Using a survey of 393 employees who were natives and residents of China, Japan, and South Korea, we examined the extent to which employees from different countries within East Asia experience distributive justice when they perceived that their work outcomes relative to a referent other were equally poor, equally favorable, more poor, or more favorable. As predicted, we found that when employees perceived themselves relative to a referent other to be recipients of more favorable outcomes, Chinese and Korean employees were (...) less likely than Japanese employees to experience distributive injustice. We also found that these differences were partially mediated by employees’ level of materialism. Theoretical and practical implications of our findings are discussed. (shrink)

Recent data indicate that under a specific posthypnotic suggestion to circumvent reading, highly suggestible subjects successfully eliminated the Stroop interference effect. The present study examined whether an optical explanation could account for this finding. Using cyclopentolate hydrochloride eye drops to pharmacologically prevent visual accommodation in all subjects, behavioral Stroop data were collected from six highly hypnotizables and six less suggestibles using an optical setup that guaranteed either sharply focused or blurred vision. The highly suggestibles performed the Stroop task when naturally (...) vigilant, under posthypnotic suggestion not to read, and while visually blurred; the less suggestibles ran naturally vigilant, while looking away, and while visually blurred. Although visual accommodation was precluded for all subjects, posthypnotic suggestion effectively eliminated Stroop interference and was comparable to looking away in controls. These data strengthen the view that Stroop interference is neither robust nor inevitable and support the hypothesis that posthypnotic suggestion may exert a top-down influence on neural processing. (shrink)

Supported decision making, as outlined by Peterson et al. highlights real-world challenges in the messy context of clinical care. We agree with Peterson et al. that patients...

For over a decade, managed care has profoundly altered how healthcare is delivered in the United States. There have been concerns that the patient-physician relationship may be undermined by various aspects of managed care, such as restrictions on physician choice, productivity requirements that limit the time physicians may spend with patients, and the use of compensation formulas that reward physicians for healthcare dollars not spent. We have previously published data on the effects of managed care on the physician-patient relationship from (...) the physician's perspective. In 1999, we collected data on the impact of managed care arrangements on the physician-patient relationship from the patient's perspective. This article discusses our collective findings. (shrink)

Over the past several years, healthcare has been profoundly altered by the growth of managed care. Because managed care integrates the financing and delivery of healthcare services, it dramatically alters the roles and relationships among providers, payers, and patients. While analysis of this change has focused on whether and how managed care can control costs, an increasingly important concern among healthcare providers and recipients is the impact of managed care on the physicianpatient relationship, but little data have been collected and (...) analyzed. We designed a survey for distribution to Wisconsin physicians to analyze the prevalence and types of managed care arrangements in the state, and the impact of these arrangements on physicians and their relationships with patients. (shrink)

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the (...) public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care. (shrink)

Too many patients are injured in the course of care. Clinicians may mistakenly cause new harm to a patient or fail to take established steps to improve the presenting condition. Medical institutions within which they work may lack mechanisms to reduce errors or prevent them from harming patients. Many, perhaps even most, injuries are preventable, probably numbering in the hundreds of thousands a year for hospital care alone. Long ignored by medical practitioners and health-care payers and little appreciated by the (...) public, the problem of medical injury is finally receiving high-level policy attention. Much credit goes to the Institute of Medicine for its landmark report of November 1999, which marshaled the evidence about medical injuries and highlighted new approaches to systematic improvement of safety within systems of care. (shrink)

ABSTRACT Recruitment into the scientific community is one oft-stated goal of science education—in the post-Sputnik United States, for example—but this obscures the fact that science textbooks are often read by people who will never be scientists. It cannot be presupposed that science textbooks for younger audiences, students in primary and secondary schools, function in this way. For this reason, precollegiate-level science textbooks are sometimes discussed as a subset of literature popularizing science. The high school science classroom and the textbook are (...) forums for exposing the public to science. The role of governments and educational institutions in regulating the consumption of these texts not only determines which books are used; it influences how they are written, read, and deemed authoritative. Therefore such science textbooks should not be seen as (at best) the disjunction of texts-for-training and books-for-popularization. A changing sense of what “textbooks” are compels a different understanding of their use in the history of science. (shrink)

In discussing the origins of the antievolution movement in American high schools within the framework of science and religion, much is overlooked about the influence of educational trends in shaping this phenomenon. This was especially true in the years before the 1925 Scopes trial, the beginnings of the school antievolution movement. There was no sudden realization in the 1920's – sixty years after the "Origin of Species" was published – that Darwinism conflicted with the Bible, but until evolution was being (...) taught in the high schools, there was no impetus to outlaw it. The creation of "civic biology" curricula in the late 1910's and early 20's, spearheaded by a close-knit community of textbook authors, brought evolution into the high school classroom as part of a complete reshaping of "biology" as a school subject. It also incorporated progressive ideologies about the purposes of compulsory public education in shaping society, and civic biology was fundamentally focused on the applications of the life sciences to human life. Antievolution legislation was part of a broader response to the ideologies of the new biology field, and was a reaction not only to the content of the new subject, but to the increasingly centralized control and regulation of education. Viewing the early school antievolution movement through the science-religion conflict is an artifact of the Scopes trial's re-creation of its origins. What largely caused support for the school antievolution movement in the South and particularly Tennessee were concerns over public education, which biology came to epitomize. (shrink)

Democracy has been a flawed hegemony since the fall of communism. Its flexibility, its commitment to equality of representation, and its recognition of the legitimacy of opposition politics are all positive features for political institutions. But democracy has many deficiencies: it is all too easily held hostage by powerful interests; it often fails to advance social justice; and it does not cope well with a number of features of the political landscape, such as political identities, boundary disputes, and environmental crises. (...) Although democracy is valuable it fits uneasily with other political values and is in many respects less than equal to the demands it confronts. In this volume prominent political theorists and social scientists present original discussions of such central issues. Democracy's Values deals with the nature and value of democracy, particularly the tensions between it and such goods as justice, equality, efficiency, and freedom. (shrink)

R. Marie Griffith and Sarah Coakley suggest that feminist ecumenism across the evangelical-liberal spectrum is valuable for feminist studies of religion and theologies. In this context, I trace the conversation that has arisen around the idea of adopting ‘submission’ vis-à-vis the Christian notion of kenosis, and turn it in a new direction. I argue that Coakley’s apophatically cruciform understanding of submission in contemplative prayer contrasts with womanist approaches like that of Delores Williams. Drawing on Williams’ considerations of atonement and Friedrich (...) Schleiermacher’s understanding of prayer, I offer ‘incarnational submission’ as a way to acknowledge the value of prayerful submission while avoiding its potentially oppressive features. (shrink)

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

We develop a point-free construction of the classical one- dimensional continuum, with an interval structure based on mereology and either a weak set theory or logic of plural quantification. In some respects this realizes ideas going back to Aristotle,although, unlike Aristotle, we make free use of classical "actual infinity". Also, in contrast to intuitionistic, Bishop, and smooth infinitesimal analysis, we follow classical analysis in allowing partitioning of our "gunky line" into mutually exclusive and exhaustive disjoint parts, thereby demonstrating the independence (...) of "indecomposability" from a non-punctiform conception. It is surprising that such simple axioms as ours already imply the Archimedean property and that they determine an isomorphism with the Dedekind-Cantor structure of R as a complete, separable, ordered field. We also present some simple topological models of our system, establishing consistency relative to classical analysis. Finally, after describing how to nominalize our theory, we close with comparisons with earlier efforts related to our own. (shrink)

This paper uses neo-Fregean-style abstraction principles to develop the integers from the natural numbers (assuming Hume’s principle), the rational numbers from the integers, and the real numbers from the rationals. The first two are first-order abstractions that treat pairs of numbers: (DIF) INT(a,b)=INT(c,d) ≡ (a+d)=(b+c). (QUOT) Q(m,n)=Q(p,q) ≡ (n=0 & q=0) ∨ (n≠0 & q≠0 & m⋅q=n⋅p). The development of the real numbers is an adaption of the Dedekind program involving “cuts” of rational numbers. Let P be a property (of (...) rational numbers) and r a rational number. Say that r is an upper bound of P, written P≤r, if for any rational number s, if Ps then either s<r or s=r. In other words, P≤r if r is greater than or equal to any rational number that P applies to. Consider the Cut Abstraction Principle: (CP) ∀P∀Q(C(P)=C(Q) ≡ ∀r(P≤r ≡ Q≤r)). In other words, the cut of P is identical to the cut of Q if and only if P and Q share all of their upper bounds. The axioms of second-order real analysis can be derived from (CP), just as the axioms of second-order Peano arithmetic can be derived from Hume’s principle. The paper raises some of the philosophical issues connected with the neo-Fregean program, using the above abstraction principles as case studies. (shrink)

§1. Overview. Philosophers and mathematicians have drawn lots of conclusions from Gödel's incompleteness theorems, and related results from mathematical logic. Languages, minds, and machines figure prominently in the discussion. Gödel's theorems surely tell us something about these important matters. But what?A descriptive title for this paper would be “Gödel, Lucas, Penrose, Turing, Feferman, Dummett, mechanism, optimism, reflection, and indefinite extensibility”. Adding “God and the Devil” would probably be redundant. Despite the breath-taking, whirlwind tour, I have the modest aim of forging (...) connections between different parts of this literature and clearing up some confusions, together with the less modest aim of not introducing any more confusions.I propose to focus on three spheres within the literature on incompleteness. The first, and primary, one concerns arguments that Gödel's theorem refutes the mechanistic thesis that the human mind is, or can be accurately modeled as, a digital computer or a Turing machine. The most famous instance is the much reprinted J. R. Lucas [18]. To summarize, suppose that a mechanist provides plans for a machine,M, and claims that the output ofMconsists of all and only the arithmetic truths that a human, or the totality of human mathematicians, will ever or can ever know. We assume that the output ofMis consistent. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:258 HISTORY OF PHILOSOPHY To make this theme conspicuous to the reader, the author deals with three topics in Aristotle's first philosophy: the path from beings to the primary instance of being, the study of sensible substance, and the distinction between the potential and the actual. Grene's essay on the most perplexing of Aristotle's works is the least satisfactory in her study. Though she acknowledges that the path of (...) thg Aristotelian first philosopher is not easy, her analysis of the school X67oLmakes the road more facile than it, in fact, is. For example, what is the relation between Wisdom (the science of principles and causes), the science of being-qua-being, and the science of immovable substance? How can the latter be universal and, at the same time, have as its object one kind of being? Why does Aristotle dismiss substrate in the sense of compound of form and matter as a candidate for substance? It would seem to satisfy his criteria of thisness and separability better (or at least in more instances) than substrate in the sense of form. Finally, it is hard to avoid Ross's conclusion (Aristotle's Metaphysics, Vol. 1, pp. ci) that Aristotle in Book Z moves away from the view that the primary ontological units are sensible individuals toward the view that they are pure forms. The real is either the object of definition (and this appears to be Aristotle's view for the most part in Book Z) or it is the individual (the doctrine of the Categories); it cannot, on Aristotelian grounds, be both. Grene's resolution of the difficulty will not bear scrutiny. She says (p. 205): "Definition is of the universal. But the object of definition is the real substance, the being-what-it-is of the thing. This is substance and not universal." The incompatibility of the first and third sentences in this passage constitutes what Grene refers to (p. 205) as "a very perplexing situation indeed;" and they also reflect the "double meaning" which "pervades Aristotle's whole treatment of substance" (Ross, Aristotle, p. 166). It is the doctrine of the first sentence which comes to the fore in Book Z, for there Aristotle concludes (i) that ot~r is r6 I"L~Tv e~tL and maintains (ii) that rb rl ~v rival 'will belong to nothing which is not a species of a genus' (1030"12-13). And we hardly need be reminded that an Aristotelian species is not an individual. Grene, it seems to me, relieves our perplexity somewhat, but only by blurring the oscillation in Aristotle's mind on this point, e.g., when she implies that the unambiguous doctrine of Book Z is that "as far as the perceived world goes, the naturalist's specimen, the individual of a type, the member of a class, is the prototype of the real" (p. 205). In very readable prose Grene has given us a picture of Aristotle that is at once engaging and in most respects faithful to the interests and outlook of her model. She says in a bibliographical note that her book is "meant more for the undergraduate reader or the general public than for scholars already conversant both with the text and the tradition" (p. 257). I suggest that the account Grene has given us is stimulating and refreshing also for the scholar. JosxAtt B. GOULD,JR. Glaremont Graduate School La filosofia medievale: Antologia di testi. Edited by Nicola Abbagnan0. (Bari: Editori Laterza, 1963. Pp. 440. -----Coll. del Candelaio. L. 2700.) it is the purpose of this, the second volume in the Antologia di testi filosofici to appear under the general editorship of the fine Italian scholar, Nicola Abbagnano, to provide an introduction to the history of mediaeval philosophy through the presentation of selected primary source materials in Italian translation. The book could have been a significant addition to the sparse philosophical literature of the period that is now available BOOK REVIEWS 259 to the non-Latin reader; instead, it turns out to be a sort of catalogue of opinions on a wide variety of philosophical topics held by many of the thinkers active in the period: between St... (shrink)

Recent studies have characterized R. Hayyim of Volozhin as actively preparing for the messianic redemption. Contrary to this, I maintain that R. Hayyim was concerned with the immediate potential of the world in the context of historical time , rather than with a world-to-come, in the context of messianic time . To R. Hayyim, the existence of the cosmos and the stability of a dynamic life-giving universe are fraught with contingency because of the interdependent organic naturality shared by man and (...) world. This contingency is constant, placing man's conduct as the central determinant of the world's future. R. Hayyim's theory and practice attest to a concern for the immanent and transcendent aspects of this world and for the meanings of our everyday experienced relationship to its variegated pragmata. (shrink)

Shelly Kagan has recently defended the view that it is morally worse for a human being to suffer some harm than it is for a lower animal (such as a dog or a cow) to suffer a harm that is equally severe (ceteris paribus). In this paper, I argue that this view receives rather less support from our intuitions than one might at first suppose. According to Kagan, moreover, an individual’s moral status depends partly upon her ‘modal capacities.’ In (...) this paper, I argue that the most natural strategy for justifying Kagan’s theory faces some important challenges. More generally, I argue that philosophers who wish to defend the view that human beings have a higher moral status than that of the lower animals face a dilemma. Either their theory of moral status will imply (unacceptably) that some severely cognitively impaired human beings have a significantly lower moral status than that of typical human beings, or these philosophers will be forced to ground moral status in a set of properties so far removed from a subject’s actual capacities that it will become difficult to see why these kinds of properties should have such moral importance. (shrink)