A fascinating exploration of the very essence of life itself sheds new light on the order and evolution in complex life systems and defines and explains autonomous agents and work within the contexts of thermodynamics and information theory, setting the stage for a dramatic technological revolution. 50,000 first printing.

At Home in the Universe presents and extends the intellectual core ofKauffman's earlier book The Origins of Order (OUP 1993) for any intelligentgeneral reader can understand and appreciate. The reader is very effectivelyinvited into Kauffman's vision and thought processes, in one of the moreexhilarating and important books of popular science.

Background Institutional Review Boards (IRBs) are federally mandated to include both nonscientific and unaffiliated representatives in their membership. Despite this, there is no guidance or policy on the selection of unaffiliated or non-scientist members and reports indicate a lack of clarity regarding members’ roles. In the present study we sought to explore processes of recruitment, training, and the perceived roles for unaffiliated and non-scientist members of IRBs.Methods We distributed a self-administered REDCap survey of members of the Association for the Accreditation (...) of Human Research Protection Programs familiar with IRB member recruitment. The survey included closed and open-ended questions regarding: the operation of the HRPP/IRB(s), how unaffiliated and non-scientist members are recruited, whether they had faced challenges recruiting for these roles, and training and mentorship offered. The survey also collected information regarding the perceived value and roles of unaffiliated and non-scientist members.Results 76 responses were included in the analysis (38% completion rate). The most common approach for recruitment was referral from current IRB members, with almost half of respondents indicating challenges recruiting unaffiliated members. Over 75% indicated no additional training was provided to unaffiliated or non-scientist members compared to affiliated or scientist members. Most common supports provided were travel/parking expenses and honoraria. Commonly perceived roles were to provide an independent voice from the participant perspective, notably regarding consent processes and materials.Conclusions Respondents indicated challenges in defining unaffiliated and non-scientist members and limited practices toward recruitment and support. Future work should more closely examine the challenges in defining these roles and applying the definitions in practice, as well as strategies that may improve recruitment and retention of unaffiliated and non-scientist members. (shrink)

Explores the possiblity and process of evolution beyond the standard and established scientific principles.

The concept of social structure is ill defined in the literature despite the perennial problem and ongoing discussion about the relationship between agency and structure. In this paper I will provide an outline of what the term social structure means, but my main focus will be on emphasizing the value of the concept for nursing research and demonstrate how its erasure in some research negatively effects on our understanding of the nurses' role in clinical practice. For example, qualitative research in (...) nursing has largely focused on agency through such theories as phenomenology, hermeneutics, and symbolic interactionism. The result is that social structure may be erased or seen as epiphenomena of agency. My purpose is to provide a theoretical discussion of social structure and how such a discussion can help us to understand how nurses live and experience clinical practice. While not denying the importance of agency, I will argue that the thinned out approach to social structure places limits on our understanding of the constraints nurses experience in their working lives. The result is that nurses' attitudes and clinical failings are individualized, resulting in ever more calls for improved education, when a more thorough examination of structural issues may elucidate more fundamental problems. (shrink)

In this fascinating read, Kauffman concludes that the development of life on earth is not entirely predictable, because no theory could ever fully account for the limitless variations of evolution. Sure to cause a stir, this book will be discussed for years to come and may even set the tone for the next "great thinker.".

As a system of knowledge, nursing has utilized a range of subjects and reconstituted them to reflect the thinking and practice of health care. Often drawn to a holistic model, nursing finds it difficult to resist the reductionist tendencies in biological and medical thinking. In this paper I will propose a relational approach to knowledge that is able to address this issue. The paper argues that biology is not characterized by one stable theory but is often a contentious topic and (...) employs philosophically diverse models in its scientific research. Biology need not be seen as a reductionist science, but reductionism is nonetheless an important current within biological thinking. These reductionist currents can undermine nursing knowledge in four main ways. Firstly, that the conclusions drawn from reductionism go far beyond their data based on an approach that prioritizes biological explanations and eliminates others. Secondly, that the methods employed by biologists are sometimes weak, and the limitations are insufficiently acknowledged. Thirdly, that the assumptions that drive the research agenda are problematic, and finally that uncritical application of these ideas can be potentially disastrous for nursing practice. These issues are explored through an examination of the problems reductionism poses for the issue of gender, mental health, and altruism. I then propose an approach based on critical realism that adopts an anti‐reductionist philosophy that utilizes the conceptual tools of emergence and a relational ontology. (shrink)

This paper will explore the relationship between Mezirow's concept of reflexivity and Bourdieu's theory of habitus in order to develop a more robust framework within which critical reflection can take place. Nurse educators have sought to close the theory practice gap through the use of critical reflection. However, we are not convinced that this has produced the depth and quality of reflection required. Furthermore, the contexts in which critical reflection takes place is often sidelined or erased so that the whole (...) impetus in the literature is to educate nurses in reflection rather than empower nurses to understand the complex circumstances and barriers that obstruct critical reflection. This paper argues that the reason for this position is that nurse education does not always acknowledge the role that personal and cultural values systems have on reflective practices. The literature search was undertaken using CINHAL and MEDLINE. Keywords included: values systems, habitus, and critical reflection. Inclusion criteria were determined by the theoretical approach and included seminal texts, from as far back as 1956, to identify key themes. Although critical reflection is a potentially powerful way of enhancing care it has often failed to do so. It is suggested that this is because nurse educators have frequently used models of reflection without considering the impact that student's personal values systems has on their perceptions of care and subsequently care delivery. The purpose of this paper is to promote deeper levels of reflection and is part of a programme of research aimed at developing a more robust approach to reflection in educational practice. (shrink)

Ultimately we will only understand biological agency when we have developed a theory of the organization of biological processes, and science is still a long way from attaining that goal. It may be possible nonetheless to develop a list of necessary conditions for the emergence of minimal biological agency. The authors offer a model of molecular autonomous agents which meets the five minimal physical conditions that are necessary (and, we believe, conjointly sufficient) for applying agential language in biology: autocatalytic reproduction; (...) work cycles; boundaries for reproducing individuals; self-propagating work and constraint construction; and choice and action that have evolved to respond to food or poison. When combined with the arguments from preadaptation and multiple realizability, the existence of these agents is sufficient to establish ontological emergence as against what one might call Weinbergian reductionism. Minimal biological agents are emphatically not conscious agents, and accepting their existence does not commit one to any robust theory of human agency. Nor is there anything mystical, dualistic, or non-empirical about the emergence of agency in the biosphere. Hence the emergence of molecular autonomous agents, and indeed ontological emergence in general, is not a negation of or limitation on careful biological study but simply one of its implications. (shrink)

BackgroundThe COVID-19 pandemic presents significant challenges to research ethics committees (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs are further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation, as well as the need to facilitate equitable access to effective treatments or vaccines for COVID-19. In South Africa, an absent National Health Research Ethics Council (NHREC) also left RECs without national guidance for (...) a significant duration of the COVID-19 pandemic. We conducted a qualitative descriptive study that explored the perspectives and experiences of RECs regarding the ethical challenges of COVID-19 research in South Africa.MethodsWe conducted in-depth interviews with 21 REC chairpersons or members from seven RECs at large academic health institutions across South Africa that were actively involved in the review of COVID-19 related research from January to April 2021. In-depth interviews were conducted remotely via Zoom. Interviews (60–125 min) were conducted in English using an in-depth interview guide, until data saturation was achieved. Audio-recordings were transcribed verbatim and field notes were converted into data documents. Line-by-line coding of transcripts was performed, and data were organised into themes and sub-themes. An inductive approach to thematic analysis was used to analyse data.ResultsFive main themes were identified, namely: rapidly evolving research ethics landscape, extreme vulnerability of research participants, unique challenges to informed consent, challenges to community engagement during COVID-19, and overlapping research ethics and public health equity issues. Sub-themes were identified for each main theme.ConclusionsNumerous, significant ethical complexities and challenges were identified by South African REC members in the review of COVID-19 related research. While RECs are resilient and adaptable, reviewer and REC member fatigue were major concerns. The numerous ethical issues identified also highlight the need for research ethics teaching and training, especially in informed consent, as well as the urgent requirement for the development of national guidelines for research ethics during public health emergencies. Further, comparative analysis between different countries is needed to develop the discourse around African RECs and COVID-19 research ethics issues. (shrink)

Over the past few years, a growing number of people have called for reconceptualizing participation in health research as a moral obligation. John Harris argues that seriously debilitating diseases give rise to important needs, and since medical research is necessary to relieve those needs in many circumstances, people are morally obligated to act as research subjects.1 Rosamond Rhodes claims that research participation is a moral obligation for reasons of justice, beneficence, and self-development: because we all benefit significantly from modern medicine, (...) we are all required to do our part in advancing the state of medical knowledge.2 Individuals who reap the benefits of medical knowledge without contributing .. (shrink)

In 2008, researchers reported that Timothy Brown , a man with HIV infection and leukemia, received a stem-cell transplant that removed HIV from his body as far as can be detected. In 2013, an infant born with HIV infection received anti-retroviral treatment shortly after birth, but was then lost to the health care system for the next six months. When tested for HIV upon return, the child had no detectable viral load despite cessation of treatment. These remarkable clinical developments have (...) helped reinvigorate the field of ‘HIV cure’ research. (shrink)

Our aim in this article is to attempt to discuss propagating organization of process, a poorly articulated union of matter, energy, work, constraints and that vexed concept, “information”, which unite in far from equilibrium living physical systems. Our hope is to stimulate discussions by philosophers of biology and biologists to further clarify the concepts we discuss here. We place our discussion in the broad context of a “general biology”, properties that might well be found in life anywhere in the cosmos, (...) freed from the specific examples of terrestrial life after 3.8 billion years of evolution. By placing the discussion in this wider, if still hypothetical, context, we also try to place in context some of the extant discussion of information as intimately related to DNA, RNA and protein transcription and translation processes. While characteristic of current terrestrial life, there are no compelling grounds to suppose the same mechanisms would be involved in any life form able to evolve by heritable variation and natural selection. In turn, this allows us to discuss at least briefly, the focus of much of the philosophy of biology on population genetics, which, of course, assumes DNA, RNA, proteins, and other features of terrestrial life. Presumably, evolution by natural selection—and perhaps self-organization—could occur on many worlds via different causal mechanisms. Here we seek a non-reductionist explanation for the synthesis, accumulation, and propagation of information, work, and constraint, which we hope will provide some insight into both the biotic and abiotic universe, in terms of both molecular self reproduction and the basic work energy cycle where work is the constrained release of energy into a few degrees of freedom. The typical requirement for work itself is to construct those very constraints on the release of energy that then constitute further work. Information creation, we argue, arises in two ways: first information as natural selection assembling the very constraints on the release of energy that then constitutes work and the propagation of organization. Second, information in a more extended sense is “semiotic”, that is about the world or internal state of the organism and requires appropriate response. The idea is to combine ideas from biology, physics, and computer science, to formulate explanatory hypotheses on how information can be captured and rendered in the expected physical manifestation, which can then participate in the propagation of the organization of process in the expected biological work cycles to create the diversity in our observable biosphere. Our conclusions, to date, of this enquiry suggest a foundation which views information as the construction of constraints, which, in their physical manifestation, partially underlie the processes of evolution to dynamically determine the fitness of organisms within the context of a biotic universe. (shrink)

Proposed changes to the Common Rule are proffered to save almost 7,000 reviews annually and consequently vast amounts of investigator and IRB-member time. However, the proposed changes have been subject to criticism. While some have lauded the changes as being imperfect, but nevertheless as improvements, others have contended that ‘neither the scientific community nor the public can be confident that improved practices will emerge from the regulatory changes mandated by the NPRM.’ In the present article, I discuss an important aspect (...) that has been overlooked: the question of whether benefits will emerge is demonstrably empirical, yet data upon which to draw conclusions are conspicuous by their absence. This is thrown into sharp relief when we consider the current environment in which health research is increasingly focused on providing evidence of need or benefit, where there is greater emphasis on evidence-based practice, and when we have the nascent field of implementation science. (shrink)

Volume 20, Issue 10, October 2020, Page 44-47.

Web scraping involves using computer programs for automated extraction and organization of data from the Web for the purpose of further data analysis and use. It is frequently used by commercial companies, but also has become a valuable tool in epidemiological research and public health planning. In this paper, we explore ethical issues in a project that “scrapes” public websites of U.S. county jails as part of an effort to develop a comprehensive database to enhance HIV surveillance and improve continuity (...) of care for incarcerated populations. We argue that the well-known framework of Emanuel et al. provides only partial ethical guidance for the activities we describe, which lie at a complex intersection of public health research and public health practice. We suggest some ethical considerations from the ethics of public health practice to help fill gaps in this relatively unexplored area. (shrink)

Abstract:This poetic and performative work explores and expresses an apparent balancing act between sense and nonsense. Ideas of harmony, balance and reciprocity are comfortably attractive but they inevitably offer an illusory, self-satisfied, closed system that leads one back to the starting point. Or worse. Crystalline, this work continues to grow facet within facet through an apparently continual iterative process as it adapts to the requirements of each new context. Any ‘results’ are (re) absorbed into the work-process and assist continued springing (...) forward. (shrink)

The central aim of this thesis is to deconstruct and reconstruct the dominant theoretical perceptions of diplomacy, by reworking radically existing theories of diplomacy. This thesis achieves reconceptualisation of diplomatic theory by critiquing the thoughts and ideas of theorists postulating on modern diplomacy. Consequently, this thesis is concerned (largely) with the theoretical terrain of diplomacy studies. The purpose of this intended deconstruction and reconstruction is to introduce and construct three lucid types of diplomatic theory. These three types or categories introduced (...) in this thesis are Traditional, Nascent and Innovative Diplomatic Theory. By categorising these three distinct types of theories, it is hoped that the diplomatic scholar will have a choice of lenses through which to interpret the complexities of the modern diplomatic environment. Ultimately, this thesis aims to strengthen Traditional Diplomatic Theory (TDT) and introduce/construct two alternate forms of diplomatic theory, Nascent Diplomatic Theory (NDT) and Innovative Diplomatic Theory (IDT). (shrink)

ABSTRACT Written in late March 2020 in the early days of the U.S. coronavirus outbreak, this essay represents a contingent reflection on the American pandemic response, mourning in anticipation of what would soon surely unfold. I argue that the State's long-standing sacrificial economies have in this moment culminated in a suicidal State. The term is Foucault's, appearing in a controversial lecture on biopolitics, Nazism, and “biological racism.” Despite Foucault's problematic treatment of racism, I suggest that some aspects of this discourse (...) might nevertheless be apropos in our context. The U.S. pandemic response is racism's suicidal State legacy writ large: an extension and retooling of historically racist infrastructures deployed in racialized domains, but in this moment also across biosocial inequities and vulnerabilities marked by differential fungibilities other than race. (shrink)

The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in (...) health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times. (shrink)

The hole argument purportedly shows that spacetime substantivalism implies a pernicious form of indeterminism. We show that the argument is seductive only because it mistakes a trivial claim (viz. there are isomorphic models) for a significant claim (viz. there are hole isomorphisms). We prove that the latter claim is false -- thereby closing the debate about whether substantivalism implies indeterminism.

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

The use of targets to direct public health programmes, particularly in global initiatives, has become widely accepted and commonplace. This paper is an ethical analysis of the utilisation of targets in global public health using our fieldwork on and experiences with voluntary medical male circumcision initiatives in Kenya. Among the many countries involved in VMMC for HIV prevention, Kenya is considered a success story, its programmes having medically circumcised nearly 2 million men since 2007. We describe ethically problematic practices in (...) Kenyan VMMC programmes revealed by our fieldwork, how the problems are related to the pursuit of targets and discuss possible approaches to their management. Although the establishment and pursuit of targets in public health can have many benefits, assessments of target-driven programmes tend to focus on quantifiable outcomes rather than the processes by which the outcomes are obtained. However, in order to speak more robustly about programmatic ‘success’, and to maintain community trust, it is vital to ethically evaluate how a public health initiative is actually implemented in the pursuit of its targets. (shrink)

We have lived under the hegemony of the reductionistic scientific worldview since Galileo, Newton, and Laplace. In this view, the universe is meaningless, as Stephen Weinberg famously said, and organisms and a court of law are "nothing but" particles in morion. This scientific view is inadequate. Physicists are beginning to abandon reductionism in favor of emergence. Emergence, both epistemological and ontological, embraces the emergence of life and of agency. With agency comes meaning, value, and doing, beyond mere happenings. More organisms (...) are conscious. None of this violates any laws of physics, but it cannot be reduced to physics. Emergence is real, and the tiger chasing the gazelle are real parts of the real universe. We live, therefore, in an emergent universe. This emergence often is entirely unpredictable beforehand, from the evolution of novel functionalities in organisms to the evolution of the economy and human history. We are surrounded on all sides by a creativity that cannot even be prestated. Thus we have the first glimmerings of a new scientific worldview, beyond reductionism. In our universe emergence is real, and there is ceaseless, stunning creativity that has given rise to our biosphere, our humanity, and our history. We are partial co-creators of this emergent creativity. It is our choice whether we use the God word. I believe it is wise to do so. God can be our shared name for the true creativity in the natural universe. Such a view invites a new sense of the sacred, as those aspects of the creativity in the universe that we deem worthy of holding sacred. We are not logically forced to this view. Yet a global civilization, hopefully persistently diverse and creative, is emerging. I believe we need a shared view of God, a fully natural God, to orient our lives. We need a shared view of the sacred that is open to slow evolution, because rigidity in our view of the sacred violates how our most precious values evolve and invites ethical hegemony. We need a shared global ethic beyond our materialism. I believe a sense of God as the natural, awesome creativity in the universe can help us construct the sacred and a global ethic to help shape the global civilization toward what we choose with the best of our limited wisdom. (shrink)