Heyman's model, paradoxically, predicts that whereas a maximizing approach to drug choice will prevent escalation of drug use it will never yield complete abstinence. We suggest an alternative model that overcomes this difficulty by focusing on changes in drug tolerance. A small modification allows maximization to predict either abstinence or moderation (e.g., social drinking).

The insights described by Nevin & Grace may be summarized without reference to the Newtonian concepts they suggest. The metaphor to Newtonian mechanics seems dubious in three ways: (1) extensions seem to lead to paradoxes; (2) many well-known phenomena are ignored; (3) the Newtonian concepts seem difficult to reconcile with the larger framework of evolutionary theory.

At 2.00 am on the morning of May 24, 1995 the Northern Territory Legislative Assembly Australia passed the Rights of the Terminally Ill Act by the narrow margin of 15 votes to 10. The act permits a terminally ill patient of sound mind and over the age of 18 years, and who is either in pain or suffering, or distress, to request a medical practitioner to assist the patient to terminate his or her life. Thus, Australia can lay claim to (...) being the first country in the world to legalise voluntary active euthanasia. The Northern Territory's act has prompted Australia-wide community reaction, particularly in South Australia, Tasmania and the Australian Capital Territory where proposals to legalise euthanasia have already been defeated on the floor of parliament. In New South Wales (NSW) the AIDS Council of NSW has prepared draft euthanasia legislation to be introduced into the Upper House as a Private Member's Bill some time in 1996. In this paper, we focus on a brief description of events as they occurred and on the arguments for and against the legalisation of euthanasia which have appeared in the media. (shrink)

Recent literature has highlighted issues of racial discrimination in medicine. In order to explore the sometimes subtle influence of racial determinants in decisions about resource allocation, we present the case of a 53-year-old Australian Aboriginal woman with end-stage renal failure. The epidemiology of renal failure in the Australian Aboriginal population and amongst other indigenous peoples is discussed. We show that the use of utilitarian outcome criteria for resource allocation may embody subtle racial discrimination where consideration is not given to issues (...) of justice, race, culture and gender. It is only where the processes by which resources are allocated are transparent, clearly defined and based upon consultation with individual patients that issues and justice are likely to be adequately addressed. (shrink)

Ethical reasoning and decision-making may be thought of as 'professional skills', and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient's problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical practice. Not surprisingly, many (...) students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making. (shrink)

Ethical reasoning and decision-making may be thought of as 9professional skills9, and in this sense are as relevant to efficient clinical practice as the biomedical and clinical sciences are to the diagnosis of a patient9s problem. Despite this, however, undergraduate medical programmes in ethics tend to focus on the teaching of bioethical theories, concepts and/or prominent ethical issues such as IVF and euthanasia, rather than the use of such ethics knowledge (theories, principles, concepts, rules) to clinical practice. Not surprisingly, many (...) students and clinicians experience considerable difficulty in using what they know about ethics to help them make competent ethical decisions in their day-to-day clinical practice. This paper describes the development of a seminar programme for teaching senior medical students a more systematic approach to ethical reasoning and analysis and clinical decision-making. (shrink)

This book constitutes the refereed proceedings of the 7th International Conference on Theory and Applications of Satisfiability Testing, SAT 2004, held in Vancouver, BC, Canada in May 2004. The 24 revised full papers presented together with 2 invited papers were carefully selected from 72 submissions. In addition there are 2 reports on the 2004 SAT Solver Competition and the 2004 QBF Solver Evaluation. The whole spectrum of research in propositional and quantified Boolean formula satisfiability testing is covered; bringing together the (...) fields of theoretical and experimental computer science as well as the many relevant application areas. (shrink)

Despite the burgeoning literature on professionalism in other health professions, psychology lags behind in the level of attention given to this core competency. In this article, we review definitions from other health professions and how they address professionalism. Next, we review how this competency evolved within health service psychology (HSP), and we propose a definition. We offer an approach for assessing professionalism within HSP. Consideration is given to strategies and methods for providing effective education and training in this multifaceted competency. (...) Finally, recommendations are made for creating a culture of professionalism within HSP and honoring psychology’s social contract with multiple publics. (shrink)

Introduction: Screen-based and mobile technology has grown at an unprecedented rate. However, little is understood about whether increased screen-use affects executive functioning, the range of mental processes that aid goal attainment and facilitate the selection of appropriate behaviors. To examine this, a systematic review was conducted.Method: This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A comprehensive literature search was conducted using Web of Science, MEDLINE, PsycINFO and Scopus databases to identify (...) articles published between 2007 and March 2020, examining the use of mobile technologies on aspects of EF in healthy adults aged 18–35 years. In total 6079 articles were screened by title, and 39 screened by full text. Eight eligible papers were identified for inclusion. Our methods were pre-registered on the PROSPERO international prospective register of systematic reviews.Results: A total of 438 participants were included across the eight studies. Five of the eight studies examined more than one EF. Five studies measured inhibition, and four studies measured decision-making. Smartphone use was negatively associated with inhibition and decision-making. Working memory performance was found to be improved by increased time engaging in video games and by refraining from smartphone use prior to bedtime. Quality assessments indicated high risk of methodological biases across the studies and a low quality of evidence for determining the relationship between technology use and executive functioning.Conclusions: This review highlights the scarcity of the literature in this area. It presents a call for rigorous and objective research to further our understanding of the impact of mobile technology on different aspects of executive function. (shrink)

BackgroundThere has been media coverage surrounding the dangers of heavy drinking and benefits of moderation, with TV and radio presenter, Adrian Chiles, documenting his experience of moderating alcohol consumption in an online article for the Guardian. By analysing the comments in response to Chiles’ article, this study aimed to explore posters’ attitudes or beliefs toward moderating alcohol and posters’ experiences of moderating or abstaining from alcohol.MethodA secondary qualitative analysis of online comments in response to an article about moderating alcohol consumption. (...) Main outcome measures: Comments in response to a United Kingdom online news article about moderating alcohol consumption were extracted and inductive thematic analysis was used.ResultsFor aim one, two themes were developed; “general attitudes toward drinking” and “general attitudes toward reducing consumption”. These themes reflect negative perceptions of alcohol and issues around changing attitudes. For aim two, three themes were developed: “moderation vs. abstention”, “reflection on past drinking behaviours”, and “current drinking behaviours”. These themes represent posters’ experiences and implications changing their drinking habits.ConclusionOur analysis provides a novel insight into perceptions and experiences of moderating or abstaining from alcohol. Alcohol is embedded within United Kingdom culture, creating difficulties for those who choose to moderate or abstain from alcohol. Our analysis highlights the need for public health to focus on shifting the current drinking culture, through clearer drinking guidelines and a wider availability of alcohol-free alternatives. (shrink)

This volume offers a collection of in-depth explorations of pragmatism as a framework for discussions in philosophy of science and metaphysics. Each chapter involves explicit reflection on what it means to be pragmatist, and how to use pragmatism as a guiding framework in addressing topics such as realism, unification, fundamentality, truth, laws, reduction, and more. -/- .

BackgroundExisting clinical ethics support (CES) instruments are considered useful. However, users report obstacles in using them in daily practice. Including end users and other stakeholders in developing CES instruments might help to overcome these limitations. This study describes the development process of a new ethics support instrument called CURA, a low-threshold four-step instrument focused on nurses and nurse assistants working in palliative care. MethodWe used a participatory development design. We worked together with stakeholders in a Community of Practice throughout the (...) study. Potential end users (nurses and nurse assistants in palliative care) used CURA in several pilots and provided us with feedback which we used to improve CURA.ResultsWe distinguished three phases in the development process. Phase one, Identifying Needs, focused on identifying stakeholder and end user needs and preferences, learning from existing CES instruments, their development and evaluation, and identify gaps. Phase two, Development, focused on designing, developing, refining and tailoring the instrument on the basis of iterative co-creation. Phase three, Dissemination, focused on implementation and dissemination. The instrument, CURA, is a four-step low-threshold instrument that fosters ethical reflection.ConclusionsParticipatory development is a valuable approach for developing clinical ethics support instruments. Collaborating with end users and other stakeholders in our development study has helped to meet the needs and preferences of end users, to come up with strategies to refine the instrument in order to enhance its feasibility, and to overcome reported limitations of existing clinical ethics instruments. (shrink)

This article presents an ethics support instrument for healthcare professionals called CURA. It is designed with a focus on and together with nurses and nurse assistants in palliative care. First, we shortly go into the background and the development study of the instrument. Next, we describe the four steps CURA prescribes for ethical reflection: (1) Concentrate, (2) Unrush, (3) Reflect, and (4) Act. In order to demonstrate how CURA can structure a moral reflection among caregivers, we discuss how a case (...) was discussed with CURA at a psychogeriatric ward of an elderly care home. Furthermore, we go into some considerations regarding the use of the instrument in clinical practice. Finally, we focus on the need for further research on the effectiveness and implementation of CURA. (shrink)

This article discusses the nature of euthanasia, and the way in which redevelopment of the concept of euthanasia in some influential recent philosophical writing has led to morally less discriminating killing/letting die/not saving being misdescribed as euthanasia. Peter Singer's defence of non-voluntary ‘euthanasia’of defective infants in his influential book Practical Ethics is critically evaluated. We argue that Singer's pseudo-euthanasia arguments in Practical Ethics are unsatisfactory as approaches to determining the legitimacy of killing, and that these arguments present a total utilitarian (...) improvement policy—not a case for non-voluntary euthanasia. (shrink)

In video games, identification with avatars—virtual entities or characters driven by human behavior—has been shown to serve many interpersonal and intraindividual functions but our understanding of the psychological variables that influence players' avatar choices remains incomplete. The study presented in this paper tested whether players' preferred style of avatar creation is linked to the magnitude of self-perceived discrepancies between who they are, who they aspire to be, and who they think they should be. One-hundred-and-twenty-five undergraduate gamers indicated their preferred avatar (...) creation style and completed a values measure from three different perspectives: their actual, ideal, and ought selves. The average actual/ideal values discrepancy was greater among those who preferred idealized avatars vs. those who preferred realistic avatars. The average actual/ought values discrepancy was greater among those who preferred completely different avatars vs. those who preferred realistic avatars. These results, therefore, offer additional evidence that self-discrepancy theory is a useful framework for understanding avatar preferences. (shrink)

Gratitude has been promoted as a beneficial emotional experience. However, gratitude is not universally experienced as positive. The current work examines whether an autonomous interpersonal style is associated with differential experience of gratitude. Study 1 found an inverse relationship between trait autonomy and both trait gratitude and positivity of response to receiving a hypothetical benefit from a friend. Study 2 replicated the finding that those higher in autonomy report less trait gratitude, and also demonstrated an inverse relationship between autonomy and (...) valuing gratitude. Study 3 found that those higher in autonomy had more self-image goals and reduced compassionate goals in relationships, and that valuing gratitude mediated the relationship between autonomy and relationship goals. These results show a consistent inverse relationship between autonomy and the experience and valuing of gratitude, suggesting that degree of autonomy is one determinant of whether gratitude is experienced as positive. (shrink)

The objective of this study is to evaluate if use of a patient decision aid, when choosing between a repeat cesarean or a trial of labor after a cesarean, reduces medical liability exposure. The authors conclude that use of a PDA conferred liability protection when potential jurors were presented with a hypothetical malpractice claim against an obstetrician following a TOLAC.

Each Girard quantale (i.e., commutative quantale with a selected dualizing element) provides a support for a semantics for linear propositional formulas (but not for linear derivations). Several constructions of Girard quantales are known. We give two more constructions, one using an arbitrary partially ordered monoid and one using a partially ordered group (both commutative). In both cases the semantics can be controlled be a relation between pairs of elements of the support and formulas. This gives us a neat way of (...) handling duality. (shrink)

Each Girard quantale provides a support for a semantics for linear propositional formulas. Several constructions of Girard quantales are known. We give two more constructions, one using an arbitrary partially ordered monoid and one using a partially ordered group. In both cases the semantics can be controlled be a relation between pairs of elements of the support and formulas. This gives us a neat way of handling duality.

In the Statesman , Plato brings together--only to challenge and displace--his own crowning contributions to philosophical method, political theory, and drama. In his 1980 study, reprinted here, Mitchell Miller employs literary theory and conceptual analysis to expose the philosophical, political, and pedagogical conflict that is the underlying context of the dialogue, revealing that its chaotic variety of movements is actually a carefully harmonized act of realizing the mean. The original study left one question outstanding: what specifically, in the metaphysical (...) order of things, motivated the nameless Visitor from Elea to abandon bifurcation for his consummating non-bifurcatory division of fifteen kinds at the end of the dialogue? Miller addressed in a separate essay, first published in 1999 and reprinted here. In it, he opens the horizon of interpretation to include the new metaphysics of the Parmenides , the Philebus , and the "unwritten teachings." "This study demonstrates how the Statesman is the culminating expression of Plato's lifelong effort, both in Athens and in the Academy, to bring metaphysical insight to the unending political crisis of his times."The Philosopher in Plato's Statesman a trail-blazing work. While not every reader will agree with the lessons Miller himself draws from this approach, none should fail to be impressed by its interpretive power. All this is exciting stuff. The interpretive pathway on which Miller has embarked has the potential for changing the face of scholarship on the late Platonic dialogues. Parmenides [Publishing] is to be commended for making these two important contributions available under a single cover." -- Kenneth Sayre, Professor of Philosophy, University of Notre Dame "Miller casts considerable light on virtually every aspect of the dialogue. . . . All in all, this book is an outstanding contribution to our understanding of the Statesman." -- Stanley Rosen, Borden Parker Bowne Professor of Philosophy, Boston University MITCHELL MILLER is Professor of Philosophy at Vassar College. He is the author of Plato's Parmenides. (shrink)

In the management and business ethics literatures, stakeholder engagement has been demonstrated to lead to more ethical management practices. However, there may be limits on the extent to which stakeholder engagement can, as currently conceptualized, resolve some of the more difficult ethical challenges faced by managers. In this paper we argue that stakeholder engagement, when seen as a way of reducing five types of knowledge problems—risk, ambiguity, complexity, equivocality, and a priori irreducible uncertainty—can aid managers in resolving such ethical challenges. (...) Using a practical illustration of the ethical challenges surrounding the development and application of genetic modification technologies, we demonstrate how stakeholder engagement enables managers to better address these knowledge problems, thereby to manage more ethically. In this way, we suggest that stakeholder engagement has an even more crucial role to play in business ethics research and practice. (shrink)

The Parmenides is arguably the pivotal text for understanding the Platonic corpus as a whole. I offer a critical analysis that takes as its key the closely constructed dramatic context and mimetic irony of the dialogue. Read with these in view, the contradictory characterizations of the "one" in the hypotheses dissolve and reform as stages in a systematic response to the objections that Parmenides earlier posed to the young Socrates' notions of forms and participation, potentially liberating Socrates from his dependence (...) on sensible simile and yielding a distinctively conceptual articulation of the difference and relation of forms and their sensible participants. The dialogue as a whole thereby functions as the means for the "conversion" of the soul to eidetic being for which Plato has the elder Socrates call in Republic VII. (shrink)

This is the first book to evaluate the significance and usefulness of the practices of anthropomorphism and anecdotalism for understanding animals.

Scientific editors’ policies, including peer review, are based mainly on tradition and belief. Do they actually achieve their desired effects, the selection of the best manuscripts and improvement of those published? Editorial decisions have important consequences—to investigators, the scientific community, and all who might benefit from correct information or be harmed by misleading research results. These decisions should be judged not just by intentions of reviewers and editors but also by the actual consequences of their actions. A small but growing (...) number of studies has put editorial policies to a strong scientific test. In a randomized, controlled trial. blinding reviewers to author and institution was usually successful and improved the quality of reviews. Two studies have shown that, contrary to conventional wisdom, reviewers early in their careers give better reviews than senior reviewers. Many studies have shown low agreement between reviewers but there is disagreement about whether this represents a failing of peer review or the expected and valuable effect of choosing reviewers with complementary expertise. In a study of whether manuscripts are improved by peer review and editing, articles published in Annals of Internal Medicine were improved in 33 of 34 dimensions of reporting quality, but published articles still had room for improvement. Because of the central place of peer review in the scientific community and the resources it requires, more studies are needed to define what it does and does not accomplish. (shrink)

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, (...) not evidence. (shrink)

Recent advances in the field of statistical learning have established that learners are able to track regularities of multimodal stimuli, yet it is unknown whether the statistical computations are performed on integrated representations or on separate, unimodal representations. In the present study, we investigated the ability of adults to integrate audio and visual input during statistical learning. We presented learners with a speech stream synchronized with a video of a speaker’s face. In the critical condition, the visual (e.g. /gi/) and (...) auditory (e.g. /mi/) signals were occasionally incongruent, which we predicted would produce the McGurk illusion, resulting in the perception of an audiovisual syllable (e.g. /ni/). In this way, we used the McGurk illusion to manipulate the underlying statistical structure of the speech streams, such that perception of these illusory syllables facilitated participants’ ability to segment the speech stream. Our results therefore demonstrate that participants can integrate audio and visual input to perceive the McGurk illusion during statistical learning. We interpret our findings as support for modality-interactive accounts of statistical learning. (shrink)

Background: Clinical ethics support instruments aim to support healthcare professionals in dealing with moral challenges in clinical practice. CURA is a relatively new instrument tailored to the wishes and needs of healthcare professionals in palliative care, especially nurses. It aims to foster their moral resilience and moral competences. Aim: To investigate the effects of using CURA on healthcare professionals regarding their Moral Resilience and Moral Competences. Design: Single group pre-/post-test design with two questionnaires. Methods: Questionnaires used were the Rushton Moral (...) Resilience Scale measuring Moral Resilience and the Euro-MCD, measuring Moral Competences. Respondents mainly consisted of nurses and nurse assistants who used CURA in daily practice. Forty-seven respondents contributed to both pre- and post-test with 18 months between both tests. Analysis was done using descriptive statistics and Wilcoxon signed rank tests. This study followed the SQUIRE checklist. Ethical considerations: This study was approved by the Institutional Review Board of Amsterdam UMC. Informed consent was obtained from all respondents. Results: The total Moral Resilience score and the scores of two subscales of the RMRS, that is, Responses to Moral Adversity and Relational Integrity, increased significantly. All subscales of the Euro-MCD increased significantly at posttest. Using CURA more often did not lead to significant higher scores on most (sub) scales. Conclusion: This study indicates that CURA can be used to foster moral resilience and moral competences of healthcare professionals. CURA therefore is a promising instrument to support healthcare professionals in dealing with moral challenges in everyday practice. (shrink)

An effort to track the movement of thought in the proem of the poem in order to discover in it the context for the disclosure of the "is" in fr. s 2 and 8. Close attention to symbolic imagery and historical allusions, and to the philosophical power of the unthinkable "nothing". (For a renewed and expanded effort, see the author's "Ambiguity and Transport: Reflections on the Proem to Parmenides' Poem," Oxford Studies in Ancient Philosophy xxx [2006], 1-47.).