Drawing on a longitudinal case study of a 10‐year cross‐sector partnership for development in Colombia, this paper makes three contributions to current discussions on new collaborative governance approaches in which business, non‐governmental organizations and development agencies jointly address development challenges. First, our study explores how partnerships can be successful in achieving longer term development while being designed as short‐term governance arrangements. Second, we shed light on how power asymmetries can shape partnership governance. Many studies have highlighted the negative aspects of (...) donor involvement in cross‐sector partnerships. We identify, however, that an interplay of formal and informal governance in partnerships can provide a positive enabling framework for partner relationships to grow and mature. Third, the case highlights that the studied partnership employed governance mechanisms that facilitate local ownership and empower small‐scale farmers, which effected (longer term) value chain relationships. In this regard, our case study helps to understand governance processes and conditions under which transformative local partnerships can emerge and sustain in post‐conflict settings. The paper adds observations on the collaborative governance content that is required for a more integrative research approach to corporate contributions to development. (shrink)

Research questions and backgroundThis study explores a highly controversial issue of medical care in Germany: the decision to withhold or withdraw mechanical ventilation in critically ill patients. It analyzes difficulties in making these decisions and the physicians’ uncertainty in understanding the German terminology of Sterbehilfe, which is used in the context of treatment limitation. Used in everyday language, the word Sterbehilfe carries connotations such as helping the patient in the dying process or helping the patient to enter the dying process. (...) Yet, in the legal and ethical discourse Sterbehilfe indicates several concepts: (1) treatment limitation, i.e., withholding or withdrawing life-sustaining treatment (passive Sterbehilfe), (2) the use of medication for symptom control while taking into account the risk of hastening the patient’s death (indirekte Sterbehilfe), and (3) measures to deliberately terminate the patient’s life (aktive Sterbehilfe). The terminology of Sterbehilfe has been criticized for being too complex and misleading, particularly for practical purposes. Materials and methods An exploratory study based on qualitative interviews was conducted with 28 physicians from nine medical intensive care units in tertiary care hospitals in the German federal state of Baden-Wuerttemberg. The method of data collection was a problem-centered, semi-structured interview using two authentic clinical case examples. In order to shed light on the relation between the physicians’ concepts and the ethical and legal frames of reference, we analyzed their way of using the terms passive and aktive Sterbehilfe. Results Generally, the physicians were more hesitant in making decisions to withdraw rather than withhold mechanical ventilation. Almost half of them assumed a categorical prohibition to withdraw any mechanical ventilation and more than one third felt that treatment ought not to be withdrawn at all. Physicians showed specific uncertainty about classifying the withdrawal of mechanical ventilation as passive Sterbehilfe, and had difficulties understanding that terminating ventilation is not basically illegal, but the permissibility of withdrawal depends on the situation. Conclusions The physicians’ knowledge and skills in interpreting clinical ethical dilemmas require specific improvement on the one hand; on the other hand, the terms passive and aktive Sterbehilfe are less clear than desirable and not as easy to use in clinical practice. Fear of making unjustified or illegal decisions may motivate physicians to continue (even futile) treatment. Physicians strongly opt for more open discussion about end-of-life care to allow for discontinuation of futile treatment and to reduce conflict. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard University (...) (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

Two of the most influential theories about scientific inference are inference to the best explanation and Bayesianism. How are they related? Bas van Fraassen has claimed that IBE and Bayesianism are incompatible rival theories, as any probabilistic version of IBE would violate Bayesian conditionalization. In response, several authors have defended the view that IBE is compatible with Bayesian updating. They claim that the explanatory considerations in IBE are taken into account by the Bayesian because the Bayesian either does or should (...) make use of them in assigning probabilities to hypotheses. I argue that van Fraassen has not succeeded in establishing that IBE and Bayesianism are incompatible, but that the existing compatibilist response is also not satisfactory. I suggest that a more promising approach to the problem is to investigate whether explanatory considerations are taken into account by a Bayesian who assigns priors and likelihoods on his or her own terms. In this case, IBE would emerge from the Bayesian account, rather than being used to constrain priors and likelihoods. I provide a detailed discussion of the case of how the Copernican and Ptolemaic theories explain retrograde motion, and suggest that one of the key explanatory considerations is the extent to which the explanation a theory provides depends on its core elements rather than on auxiliary hypotheses. I then suggest that this type of consideration is reflected in the Bayesian likelihood, given priors that a Bayesian might be inclined to adopt even without explicit guidance by IBE. The aim is to show that IBE and Bayesianism may be compatible, not because they can be amalgamated, but rather because they capture substantially similar epistemic considerations. 1 Introduction2 Preliminaries3 Inference to the Best Explanation4 Bayesianism5 The Incompatibilist View : Inference to the Best Explanation Contradicts Bayesianism5. 1 Criticism of the incompatibilist view6 Constraint - Based Compatibilism6. 1 Criticism of constraint - based compatibilism7 Emergent Compatibilism7. 1 Analysis of inference to the best explanation7. 1. 1 Inference to the best explanation on specific hypotheses7. 1. 2 Inference to the best explanation on general theories7. 1. 3 Copernicus versus Ptolemy7. 1. 4 Explanatory virtues7. 1. 5 Summary7. 2 Bayesian account8 Conclusion. (shrink)

This paper contributes to debates regarding the normative justification of basic income (BI) via a critical reevaluation of Philippe Van Parijs’ ‘real-libertarian’ theory. Van Parijs’ work constitutes the most ambitious attempt within the literature to ground a justification of BI within a systematic normative framework. In this paper I argue that key elements of his framework should form part of any progressive justification of BI. Specifically, his linking of the principle of ‘real freedom for all’ with the policy mechanism of (...) the ‘highest sustainable basic income.’ I take issue with Van Parijs’ treatment of compensation for unequal internal endowments based on the criterion of ‘undominated diversity’ and I reject the ‘external resources’ approach to justifying the funding of a substantial BI, including Van Parijs’ ‘jobs as assets’ argument. I introduce the concept of ‘total social productivity’ as a means of understanding the production and reproduction of society in a manner that anchors the justification of BI in a commitment to a ‘deep form of social reciprocity.’ Finally, I suggest that BI be framed as a ‘pragmatic-utopian reform.’. (shrink)

Accounts of theistic faith according to which it does not involve referring to or believing in God as existing independently of the life of faith are instances of theistic reductionism. Theistic reductionism, in holding that ‘God’ does not refer to reality outside the life of believers, holds thereby that theism is not rightly to be regarded as true or false. Such accounts may be proposed or used as defenses of theistic faith. They ‘defend’ faith insofar as they describe the form (...) of life faith involves and show that the human and cultural functions it performs are valuable. Examining several reductionist accounts, ordered from weaker to stronger, I argue that they fail as defenses of theistic life and language. Whereas the reductionist views claim to leave the practice of theism as it is, I argue that in fact they imply a different form of life from the one theism actually is. Thus reductionist defenses of religious practice fail and fail precisely where they insist on treating God in some way other than as existing outside of religious life. From this I infer that theism as it exists can only be defended in ways that include taking ‘God’ as referring to a God who is real outside the life which recognizes him. The religious reductionists discussed include R.B. Braithwaite, P.F. Schmidt, Paul Holmer, Paul van Buren, Gordon Kaufman, and D.Z. Phillips. (shrink)

Accounts of theistic faith according to which it does not involve referring to or believing in God as existing independently of the life of faith are instances of theistic reductionism. Theistic reductionism, in holding that ‘God’ does not refer to reality outside the life of believers, holds thereby that theism is not rightly to be regarded as true or false. Such accounts may be proposed or used as defenses of theistic faith. They ‘defend’ faith insofar as they describe the form (...) of life faith involves and show that the human and cultural functions it performs are valuable. Examining several reductionist accounts, ordered from weaker to stronger, I argue that they fail as defenses of theistic life and language. Whereas the reductionist views claim to leave the practice of theism as it is, I argue that in fact they imply a different form of life from the one theism actually is. Thus reductionist defenses of religious practice fail and fail precisely where they insist on treating God in some way other than as existing outside of religious life. From this I infer that theism as it exists can only be defended in ways that include taking ‘God’ as referring to a God who is real outside the life which recognizes him. The religious reductionists discussed include R.B. Braithwaite, P.F. Schmidt, Paul Holmer, Paul van Buren, Gordon Kaufman, and D.Z. Phillips. (shrink)

IntroductionConcussion is a growing public health concern. No uniformly established therapy exists; neurofeedback studies report treatment value. We use infralow frequency neuromodulation to remediate disabling neurological symptoms caused by traumatic brain injury and noted improved outcomes with a novel concussion protocol. Postconcussion symptoms and persistent postconcussion symptoms are designated timelines for protracted neurological complaints following TBI. We performed a retrospective study to explore effectiveness of ILF in PCS/PPCS and investigated the value of using this concussion protocol.MethodPatients with PCS/PPCS seen for (...) their first neurology office visit or received their first neurofeedback session between 1 August 2018 and 31 January 2021 were entered. Outcomes were compared following treatment as usual vs. TAU with ILF neurotherapy. The study cohort was limited to PPCS patients; the TAU+ILF group was restricted further to PPCS patients receiving at least 10 neurotherapy sessions. Within the TAU+ILF group, comparisons were made between those who trained at least 10 sessions using concussion protocol and those who trained for at least 10 sessions of ILF regardless of protocol.ResultsAmong our resultant PPCS cohort leading persistent neurological complaints were headache, memory impairment, and brain fog. PPCS patients in TAU+ILF+CP demonstrated greater net and percent improvement of symptoms compared to PPCS subjects in TAU. PPCS patients in TAU+ILF-CP trended toward significant symptom improvements compared to TAU, and TAU+ILF+CP trended toward greater efficacy than TAU+ILF-CP.ConclusionPPCS patients who received TAU+ILF+CP demonstrated significantly greater improvement as a group when compared to TAU. When used as an integrative modality to treatment as usual in managing patients with PPCS, ILF neuromodulation with use of concussion protocol provided significant symptom improvements. (shrink)

Adult humans show exceptional relational ability relative to other species. In this research, we trace the development of this ability in young children. We used a task widely used in comparative research—the relational match-to-sample task, which requires participants to notice and match the identity relation: for example, AA should match BB instead of CD. Despite the simplicity of this relation, children under 4 years of age failed to pass this test (Experiment 1), and their performance did not improve even with (...) initial feedback (Experiment 2). In Experiments 3 and 4, we found that two kinds of symbolic-linguistic experience can facilitate relational reasoning in young children. Our findings suggest that children learn to become adept analogical thinkers, and that language fosters this learning in at least two distinct ways. (shrink)

ABSTRACT:What more can be said about COVID-19 and the social determinants of health? This article describes neglected perspectives that derive from the history of social epidemiology, a field that identifies the social etiology of disease and variations in disease incidence among people differentially located in the social structure. The "discovery" of social determinants of diseases like COVID-19 is nothing new for epidemiology: debate over how to analyze structural determinants versus individual-level risk factors persisted throughout the 19th and 20th centuries. By (...) the late 20th century, research had highlighted fundamental causes of health disparities, such as social conditions and structural racism; these are structural factors, embedded in the social fabric of life. Measurement of structured inequalities within systems faces complex and challenging problems, as research aims to better account for these lived realities at different levels of analysis and as multiple factors merge to influence outcomes (revealed in intersectionality theory). At each of these intersections, there are opportunities for bioethicists to consider their ethical implications. It is imperative to understand the social and ethical roots of our present conversations about health inequalities, in order to partner intelligently with researchers on the forefront of advocating for change. (shrink)

The current quality assurance culture demands the explicit articulation, by means of publication, of what have been hitherto tacit norms and conventions underlying disciplinary genres. The justification is that publication aids student performance and guarantees transparency and accountability. This requirement makes a number of questionable assumptions predicated upon what we will argue is an erroneous epistemology. It is not always possible to articulate in a publishable form a detailed description of disciplinary practices such as assessment. As a result publication cannot (...) achieve its stated goals. There are always elements of our knowledge that cannot be linguistically articulated. (shrink)

The dictum ‘“ought” implies “can”’ has a status in moral philosophy in some respects like that of ‘a good player needs good co-ordination’ in talk about ball-games. Clearly, you say something important but not conclusive about proficiency in playing a ball-game when you say that it requires good co-ordination: similarly, you say something important but not conclusive about obligation when you say that it implies a certain possibility or power or ability. Each dictum is a reminder: the one about such (...) courses of physical instruction, the other about such exhortations to duty, as are worth persevering with. It would be hopeless to keep on teaching a boy the moves and tricks of rugby football if he could never co-ordinate well enough to get his eye in, so to speak. Correspondingly, it would be meaningless to recommend that someone ought to do something the specification of which involved a contradiction, and pointless to suggest that he ought to do something which, for quite general reasons, was not, and was certain to remain not, within his power. So each dictum expresses a bluff, no-nonsense wisdom which we should count on before involving ourselves in certain more detailed commitments. But probably this is as far as the comparison between the two sayings can well be taken. (shrink)

In recent decades, scholars have come to see 1 Corinthians as a rhetorically unified response to the problem of divisions among Corinthian believers. This essay explores the ways in which Paul presents the cross as the organizing principle that can bind together three different forms of community division: the cult of the personality ; the freedom to eat idol meat ; and economic disparities when gathered for a meal. In each case, Paul appeals implicitly or explicitly to the cross as (...) a remedy for the all-too-familiar strains on the fractured community. In the end, Paul’s countercultural message about the cross offers a word of exhortation for the American church today, as it navigates a society that shares much in common with first-century Corinth. (shrink)

The current quality assurance culture demands the explicit articulation, by means of publication, of what have been hitherto tacit norms and conventions underlying disciplinary genres. The justification is that publication aids student performance and guarantees transparency and accountability. This requirement makes a number of questionable assumptions predicated upon what we will argue is an erroneous epistemology. It is not always possible to articulate in a publishable form a detailed description of disciplinary practices such as assessment. As a result publication cannot (...) achieve its stated goals. There are always elements of our knowledge that cannot be linguistically articulated. (shrink)

BackgroundChildhood abuse increases risk for high levels of distress in response to future stressors. Interpersonal social support is protective for health, particularly during stress, and may be particularly beneficial for individuals who experienced childhood abuse.ObjectiveInvestigate whether childhood abuse predicts levels of posttraumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic, and test whether the perceived availability of social companionship preceding the pandemic moderates this relationship.MethodsDuring Phase 1, adults (N= 120; AgeM[SD] = 19.4 [0.94]) completed a retrospective measure of childhood (...) adversity along with a measure of perceived availability of opportunities for social engagement immediately preceding the pandemic. Two weeks after the COVID-19 pandemic declaration, participants completed the Impact of Event Scale-Revised (IES-R) with respect to the pandemic. Hierarchical linear regression analyses examined the interaction between childhood abuse and the perceived availability of social companionship preceding the pandemic as a predictor of PTSD symptoms.ResultsAdjusting for covariates, the interaction between childhood abuse and perceived availability of others to engage with before the onset of the pandemic was a significant predictor of IES-hyperarousal (β = −0.19,t= −2.06,p= 0.04, ΔR2= 0.032, CI: [−0.31 to −0.01]).ConclusionLevels of perceived opportunities for social companionship before the pandemic associates with levels of hyperarousal related to the pandemic, particularly for individuals who experienced high levels of childhood abuse. More research is needed to understand how to mitigate the higher levels of distress related to the pandemic for these individuals in order to reduce risk for future psychiatric disorders. (shrink)

This essay deals with plague and plagues in renaissance and early modern Europe over the longue durée, principally from a methodological perspective. I shall combine an historiographical approach with an historical account of developing reactions to plague and in passing compare measures to cope in the early sixteenth century with reactions to the impact of the Great Pox or the Mal de Naples. I shall concentrate on southern Europe and in particular on Italy and my aim is to re-assess the (...) historiography of plague through the lens of some of the more recent Anglo-Saxon literature in this field. In the process I shall outline some of the debates within the field and end with some general methodological observations drawn from early modern Italy. (shrink)

M. Lipman and P. Freire are two thinkers who support the practice of liberty. Liberty is liberty to learn to think, and to exist in communities of dialogue, questioning, and search. This is the project that leads human beings to understand themselves and recognize others. Without liberty there..