Objective To document the legal guardian-related barriers to consent procurement, and their stated reasons for non-participation in a paediatric critical care research study.Study design A multicentre, prospective, cohort study.Participants Legal guardians of children who participated in a multicentre study on adrenal insufficiency in paediatric critical illness. Data were collected on all consent encounters in the main study.Methods Screening data, reasons for consent not being obtained, paediatric risk of mortality scores and age were collected on all 1707 patients eligible (...) for participation in the Adrenal Insufficiency Study.Results The main barriers to approaching legal guardians for consent were lack of availability of the legal guardians and language barriers . Legal guardians of 917 patients were approached with an overall consent rate of 42% . 81% of the 528 legal guardians who declined consent provided an unsolicited reason for refusal. The three most commonly stated reasons were: being overwhelmed , not wanting anything else done to their child and not wanting an additional medication . In addition, 14.2% cited research-related concerns as the reason for their non-participation.Conclusions Barriers to consent procurement in a non-therapeutic paediatric critical care study appear to occur at many levels with lack of availability of legal guardians, and legal guardians feeling overwhelmed, being the most commonly recorded reasons. Further research into the impact of these findings on the validity and generalisability of the results of such studies is necessary prior to the development and study of future consent models. (shrink)

A detailed review of hospital records, physician's notes, diaries, letters, and autopsy reports offers sufficient clinical grounds to establish that Eugene O'Neill developed adrenal insufficiency, secondary to tuberculosis, in later life--a fact hitherto unknown--the condition not becoming manifest until after he had abdominal surgery in 1936.

Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia (CAH). This intervention has been aimed at preventing development of ambiguous genitalia, the urogenital sinus, tomboyism, and lesbianism. We map out ethical problems in this history, including: misleading promotion to physicians and CAH-affected families; de facto experimentation without the necessary protections of approved research; troubling parallels to the (...) history of prenatal use of diethylstilbestrol (DES); and the use of medicine and public monies to attempt prevention of benign behavioral sex variations. Critical attention is directed at recent investigations by the U.S. Food and Drug Administration (FDA) and Office of Human Research Protections (OHRP); we argue that the weak and unsupported conclusions of these investigations indicate major gaps in the systems meant to protect subjects of high-risk medical research. (shrink)

Providing valid responses to a self-report survey requires cognitive effort. Subjects engaging in insufficient effort responding (IER) are unwilling to take this effort. Compared to psychologists, experimental philosophers so far seem to have paid less attention to IER. This paper is an attempt to begin to alleviate this shortcoming. First, I explain IER’s nature, prevalence and negative effects in self-report surveys in general. Second, I argue that IER might also affect experimental philosophy studies. Third, I develop recommendations as to how (...) experimental philosophers should (and should not) try to prevent IER. Fourth, I develop recommendations as to how experimental philosophers should (and should not) try to detect IER. Fifth, I sketch how experimental philosophers ought to proceed once a subject has been identified as an insufficient effort responder. And finally, I report the results of an online survey that addresses experimental philosophers’ current knowledge, consideration and assessment of IER. (shrink)

Various explanations have been proposed to account for complex differentiation and development in humans, despite the human genome containing only two to three times the number of genes in invertebrates. Ignored are the actions of adrenal and sex steroids—androgens, estrogens, glucocorticoids, mineralocorticoids, and progestins—which act through receptors that arose from an ancestral nuclear receptor in a protochordate. This ligand‐based mechanism is unique to vertebrates and was integrated into the already robust network of transcription factors in invertebrates. Adrenal and (...) sex steroids influence almost all aspects of vertebrate differentiation and development. I propose that evolution of this ligand‐based mechanism in a primitive vertebrate was an important contribution to vertebrate complexity. Sequencing of genomes from a cephalochordate, such as amphioxus, and from hagfish and lamprey will establish early events in the evolution of steroid hormone signaling, and also allow genetic studies to elucidate how vertebrate complexity depends on steroid hormones. BioEssays 25:396–400, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

A large number of previous reports described an effect of the pituitary hormone prolactin (PRL) on steroid hormone production by the adrenal cortex. However, those studies remained anecdotal and were never converted into a conceptual and mechanistic framework, let alone being translated into clinical care. In the light of our recently published landmark study where we described PRL signalling as a pivotal regulator of the sexually dimorphic adrenal phenotype in mouse and of adrenal androgen production in humans, (...) we present here the overarching hypothesis that PRL signalling increases the activity of Steroidogenic Factor‐1 (SF‐1/NR5A1), a transcription factor that has an essential role in adrenal gland development and function, to regulate adrenal cortex growth and hormonal production in physiological and pathological conditions. PRL can then be considered as a bona fide adrenocorticotropic hormone synergizing with ACTH in the endocrine control of adrenal cortex function. (shrink)

Abstract: Shinran (1173-1263), the founder of the Jōdoshinshū of Japanese Pure Land Buddhism, and Soren Kierkegaard (1813-1855), the Danish father of Christian existentialism, belong to very different eras, cultures, and religious traditions. Yet there are striking similarities between their religious philosophies, especially in how both offer theistic views emphasising faith and grace that see the person as radically insufficient to attain complete self-transformation. Both claim that the human person is so radically insufficient that no one can attain Buddhist enlightenment or (...) Christian salvation through his or her own power, but only through divine power. I will argue against some commentators that although the Deity accepts and transforms this insufficiency, even the power of the Deity does not eradicate human insufficiency in this life for the person of faith. I will also argue that Shinran and Kierkegaard differ significantly about the role of human freedom in faith, and that this difference expresses the central difference between Mahāyāna Buddhism and Christianity regarding the relationship between the person and the Deity. (shrink)

Byrne & Russon propose that priming can account for the imitation of simple actions, but they fail to explain how the behavior of another can prime the observer's own behavior. They also propose that imitation of complex skills requires a sequence of acts tied together by a program, but they fail to rule out the role of trial-and-error learning and perceptual/motivational mechanisms in such task acquisition.

A lively debate in the literature on moral progress concerns the role of practical reasoning: Does it enable or subvert moral progress? Rationalists believe that moral reasoning enables moral progress, because it helps enhance objectivity in thinking, overcome unruly sentiments, and open our minds to new possibilities. By contrast, skeptics argue that moral reasoning subverts moral progress. Citing growing empirical research on bias, they show that objectivity is an illusion and that moral reasoning merely rationalizes pre-existing biased moral norms. In (...) this article, I argue that both the rationalists and the skeptics fail to understand fully the role of practical reasoning by focusing exclusively on moral reasoning to the neglect of social reasoning. In the first half of the article, I argue against the skeptics by vindicating moral reasoning. I identify a Democratic Model of moral reasoning which is reliable and effective in overcoming bias. In the second part of the article, I argue against the rationalists. Drawing on a paradigmatic case of moral progress, i.e., the British abolition of the slave trade, I illustrate that moral reasoning, even when sound, is insufficient to motivate progressive action. The explanation for this puzzling phenomenon is not that the moral norm against cruelty is inert, as skeptics might suggest. Rather, it is that the moral norm against cruelty was overridden by the social norm of slavery which was tied to the British joint commitments to freedom and national honour. The debate between rationalists and skeptics centers around the moral rationality of human action, failing to recognize that human action is in fact primarily about social rationality. I defend a joint commitment account of social rationality, and offer a novel Communitarian Model of social reasoning which follows the logic of social rationality to revise social norms. I defend the reliability and efficacy of the Communitarian Model of social reasoning by applying it to the abolitionist social movement to show how Britons gave fellow Britons social reasons grounded in their joint commitments to freedom and national honour to end slavery. (shrink)

Background: Hypothalamic-pituitary-adrenal (HPA) system activation is adaptive in response to stress, and HPA dysregulation occurs in stress-related psychopathology. It is important to understand the mechanisms that modulate HPA output, yet few studies have addressed the neural circuitry associated with HPA regulation in primates and humans. Using high-resolution F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in rhesus monkeys, we assessed the relation between individual differences in brain activity and HPA function across multiple contexts that varied in stressfulness.

Bergman's views on the relation between philosophy and religion are critically examined by following his discussions of the Neo-Kantians and, among others, of Nicolaus Cusanus, Kierkegaard, Buber and Sri Aurobindo. Thereby his thesis that philosophy and religion form a unity is criticised together with his attempt atabandoning philosophy in view of its idealistic results which deprive men of actual reality. Finally it is argued that reason has to be reestablished since despite its being insufficient there is nothing to replace or (...) complement it. (shrink)

A certain number of philosophers are attracted to the idea that knowledge is the epistemic norm of practical reasoning in the sense that it is epistemically appropriate to rely on p in one’s practical reasoning if and only if one knows that p. A well-known objection to the sufficiency direction of that claim is that there are cases in which a subject supposedly knows that p and yet should not rely on p. In light of the distinction between sufficient and (...) insufficient reasons, some philosophers contend that these cases are inconclusive. In this paper, I argue that this insufficient reason manoeuvre is defective because it either misconstrues the relevant cases or is at odds with strong intuitions about how we (should) reason. I then put forward further considerations relative to the instability of some pieces of reasoning and show how they can be explained by a certainty norm for practical reasoning. (shrink)

There is much to admire in this book. As a rigorous and systematic physics-oriented presentation of an austere empiricist fundamental metaphysics, it has no real rivals. The clarity with which the overall vision is presented will provide a valuable stalking-horse for those who would defend less austere approaches in the future. Esfeld and Deckert never shy away from the radical consequences of their approach, or try to disguise its revisionary nature. I also found several points of agreement with Esfeld and (...) Deckert’s metaphysical outlook. In particular, I thought their form of structural realism sophisticated and plausible and their application of it to contemporary physics salutary. Fundamental metaphysics would be a more respectable discipline if all of its exponents felt the need to show how their preferred ontology plays out in the context of real physics. These points of agreement noted, I will concentrate in these comments on points where I disagree with Esfeld and Deckert. From my perspective, the metaphysical project of the book is subject to two serious objections: firstly, it remains insufficiently naturalistic and overly a prioristic, and secondly, it drains much of the explanatory power out of fundamental physics. (shrink)

The practical explication suggests that all attempts to state necessary and sufficient conditions for knowledge will either produce a set of conditions that is insufficient, or will achieve sufficiency only by including conditions too strong to be necessary. This is illustrated with respect to the JTB analysis, reliabilism, the causal theory, and the NFL principle. For the first three, it is always possible to think of circumstances such that, even though the subject reached the belief p by the required means, (...) she was right against all the odds, given those further circumstances. And if justification is stipulated to entail the truth of p, then this imposes an impossibly strong condition or serves merely to reiterate the famous first condition for knowledge. As for NFL, this calls for a near‐omniscience on the inquirer's part, so that it is too strong to be a necessary condition for knowledge. (shrink)

It is a common view that the axioms of probability can be derived from the following assumptions: probabilities reflect degrees of belief, degrees of belief can be measured as betting quotients; and a rational agent must select betting quotients that are coherent. In this paper, I argue that a consideration of reasonable betting behaviour, with respect to the alleged derivation of the first axiom of probability, suggests that and are incorrect. In particular, I show how a rational agent might assign (...) a ‘probability’ of zero to an event which she is sure will occur. (shrink)

The objective of the consistent-amplitude approach to quantum theory has been to justify the mathematical formalism on the basis of three main assumptions: the first defines the subject matter, the second introduces amplitudes as the tools for quantitative reasoning, and the third is an interpretative rule that provides the link to the prediction of experimental outcomes. In this work we introduce a natural and compelling fourth assumption: if there is no reason to prefer one region of the configuration space over (...) another, then they should be “weighted” equally. This is the last ingredient necessary to introduce a unique inner product in the linear space of wave functions. Thus, a form of the principle of insufficient reason is implicit in the Hilbert inner product. Armed with the inner product we obtain two results. First, we elaborate on an earlier proof of the Born probability rule. The implicit appeal to insufficient reason shows that quantum probabilities are not more objective than classical probabilities. Previously we had argued that the consistent manipulation of amplitudes leads to a linear time evolution; our second result is that time evolution must also be unitary. The argument is straightforward and hinges on the conservation of entropy. The only subtlety consists of defining the correct entropy; it is the array entropy, not von Neumann's. After unitary evolution has been established we proceed to introduce the useful notion of observables and we explore how von Neumann's entropy can be linked to Shannon's information theory. Finally, we discuss how various connections among the postulates of quantum theory are made explicit within this approach. (shrink)

This essay argues that the neo-Roman republican principle of "non-domination," as developed in the recent work of Philip Pettit, cannot serve as a single overarching political ideal, because it responds to only one of two important dimensions of concern about human agency. Through critical engagements with several aspects of Pettit's work, ranging from his philosophical account of freedom as "discursive control" to his appropriation of the distinction between dominium and imperium, the essay argues that the idea of domination, which responds (...) to concerns about "control," needs to be supplemented by the idea of usurpation, which responds to questions about "involvement"; and it shows how attention to both domination and usurpation (and to the interaction between them) can shed light on such phenomena as imperialism, slavery, and democracy. (shrink)

This article investigates the emergence of the concept of stress in the 1930s and outlines its changing disciplinary and conceptual frames up until 1960. Originally stress was a physiological concept applied to the hormonal regulation of the body under stressful conditions. Correlated closely with chemical research into corticosteroids for more than a decade, the stress concept finally became a topic in cognitive psychology. One reason for this shift of the concept to another discipline was the fact that the hormones previously (...) linked to the stress concept were successfully transferred from laboratory to medical practice and adopted by disciplines such as rheumatology and dermatology. Thus the stress concept was dissociated from its hormonal context and became a handy formula that allowed postindustrial society to conceive of stress as a matter of individual concern. From a physiological phenomenon stress turned into an object of psychological discourse and individual coping strategies. (shrink)

The paper distinguishes two types of Platonist approach, namely the Traditional one and the Robust one. In relation to this distinction I am going to argue that if the ontology of mathematics is intended to be defended plausibly in a Platonist way then this cannot be done according to the Traditional version. This will draw our attention to the plausibility of the Robust version. The plausibility of the two versions of Platonism will be examined in relation to one of the (...) central problems of the philosophy of mathematics, namely the truth-proof problem. The surveying of the truth-proof problem will bring to the surface the prima facie plausibility of the Platonist approach, as well as the apparent accessibility problem of it. Focusing on the accessibility problem will help us to identify two conditions that have to be met by any particular access theory of Platonism. These will be the reducibility condition, and the matching one. The Traditional version will appear an insufficient philosophical theory in relation to the two former conditions. The insufficiency will be demonstrated in the area of the incompatible mathematical theories, namely in the area of Euclidean and hyperbolic geometries. It will turn out that Robust Platonism can escape the squeeze of these conditions, so can it save the original prima facie plausibility of the Platonist approach. (shrink)

Bergman's views on the relation between philosophy and religion are critically examined by following his discussions of the Neo-Kantians and, among others, of Nicolaus Cusanus, Kierkegaard, Buber and Sri Aurobindo. Thereby his thesis that philosophy and religion form a unity is criticised together with his attempt atabandoning philosophy in view of its idealistic results which deprive men of actual reality. Finally it is argued that reason has to be reestablished since despite its being insufficient there is nothing to replace or (...) complement it. (shrink)

Bergman's views on the relation between philosophy and religion are critically examined by following his discussions of the Neo-Kantians and, among others, of Nicolaus Cusanus, Kierkegaard, Buber and Sri Aurobindo. Thereby his thesis that philosophy and religion form a unity is criticised together with his attempt atabandoning philosophy in view of its idealistic results which deprive men of actual reality. Finally it is argued that reason has to be reestablished since despite its being insufficient there is nothing to replace or (...) complement it. (shrink)

In the context of calls to decolonise education in European contexts, this paper draws on coloniality-based critiques of Eurocentric modernity to take up the links between democracy, slavery, and colonialism in education. Starting from the position that modernity requires epistemological support to sustain racism and white supremacy in European democracies, we read coloniality-based critiques of democracy with empirical literature about the teaching of slavery. We consider possibilities for revised critical engagements with democracy and with the history of European colonialism and (...) slavery. The paper builds on and contributes to recent decolonial critiques of democracy in education by explicitly engaging a tension raised around the possibility of disentangling democracy from its colonial roots. (shrink)

I argue that one cannot analyze scientific explanations adequately only in terms of logical relations among true propositions, Including natural laws. No pure conditional analysis of causation is possible either. I suggest that any adequate analysis of causation or explanation must bring in other factors such as time ordering or manipulability. David sanford's views are considered at length.

One well-known objection to the principle of maximum entropy is the so-called Judy Benjamin problem, first introduced by van Fraassen. The problem turns on the apparently puzzling fact that, on the basis of information relating an event’s conditional probability, the maximum entropy distribution will almost always assign to the event conditionalized on a probability strictly less than that assigned to it by the uniform distribution. In this article, I present an analysis of the Judy Benjamin problem that can help to (...) make sense of this seemingly odd feature of maximum entropy inference. My analysis is based on the claim that, in applying the principle of maximum entropy, Judy Benjamin is not acting out of a concern to maximize uncertainty in the face of new evidence, but is rather exercising a certain brand of epistemic charity towards her informant. This epistemic charity takes the form of an assumption on the part of Judy Benjamin that her informant’s evidential report leaves out no relevant information. Such a reconceptualization of the motives underlying Judy Benjamin’s appeal to the principle of maximum entropy can help to further our understanding of the true epistemological grounds of this principle and correct a common misapprehension regarding its relationship to the principle of insufficient reason. 1Introduction2The Principle of Maximum Entropy3An Apologia for Judy Benjamin4Conclusion: Entropy and Insufficient Reason. (shrink)

In a recent article in this journal, Richard Gale and Alexander Pruss offer a new cosmological proof for the existence of God relying only on the Weak Principle of Sufficient Reason, W-PSR. We argue that their proof relies on applications of W-PSR that cannot be justified, and that our modal intuitions simply do not support W-PSR in the way Gale and Pruss take them to.

It is possible to construct situations (with a suitable kind of setting) in which one speaker utters ‘This is tasty’ and another speaker responds with ‘That’s not true’. The aim of this paper is to motivate the idea that typical (broadly) expressivist accounts of taste disagreements are not in a position to explain such situations (although some of them can successfully explain disagreements in which another kind of dissent phrase—like ‘Nuh-uh’—is employed). This is because utterances of ‘That’s not true’ are (...) typically used to ascribe falsehood to propositions. Taste expressivism has it, however, that when one utters ‘This is tasty’, one typically manifests her evaluative attitude (which is non-propositional) toward something rather than describes what attitude she bears toward the thing. Another aim of the paper consists in proposing an alternative account of taste disagreements. It is close to taste expressivism when it comes to the explanation of disagreements in which speakers respond with ‘Nuh-uh’ to utterances of ‘This is tasty’, but departs from it in situations in which they respond with ‘That’s not true’. The account is developed within a contextualist framework according to which taste utterances express contextually enriched propositions that contain judges who evaluate things as tasty or not. (shrink)

Probabilities in quantum theory are traditionally given by Born’s rule as the expectation values of projection operators. Here it is shown that Born’s rule is insufficient in universes so large that they contain identical multiple copies of observers, because one does not have definite projection operators to apply. Possible replacements for Born’s rule include using the expectation value of various operators that are not projection operators, or using vari-.

Three challenges to the sufficiency of the associative account for explaining the development of mirror mechanisms are discussed: Genetic predispositions interact with associative learning, infants show predispositions to imitate human as opposed to nonhuman actions, and early and later learning involve different mechanisms. Legitimate objections to an extreme nativist account are raised, but the proposed solution is equally problematic.

The first scene-by-scene philosophical study of any Shakespeare play, this book demonstrates why Shakespeare's poetic writings still arouse and sustain serious inquiry and reflection. Using a combination of philosophical rigor, political insight, and textual thoroughness, Jan H. Blits delineates the competing forms of virtue within Macbeth--the courageous public virtue of warriors like Macbeth and the internal Christian virtue evoked by Duncan. This new interpretation of Macbeth explains crucial paradoxes overlooked by previous scholars and will serve as a model for future (...) scholarship in the field. (shrink)