Despite the recent advances in information and communication technology that have increased our ability to store and circulate information, the task of ensuring that the right sorts of information gets to the right sorts of people remains. We argue that the many efforts underway to develop efficient means for sharing information across healthcare systems and organizations would benefit from a careful analysis of human action in healthcare organizations. This in turn requires that the management of information and knowledge within healthcare (...) organizations be combined with models of resources and processes of patient care that are based on a general ontology of social interaction. The Health Level 7 (HL7) is one of several ANSI-accredited Standards Developing Organizations operating in the healthcare arena. HL7 has advanced a widely used messaging standard that enables healthcare applications to exchange clinical and administrative data in digital form. HL7 focuses on the interface requirements of the entire healthcare system and not exclusively on the requirements of one area of healthcare such as pharmacy, medical devices, imaging or insurance transactions. This has inspired the development of a powerful abstract model of patient care called the Reference Information Model (RIM). The present paper begins with an overview of the core classes of the HL7 (Version 3) RIM and a brief discussion of its “actcentered” view of healthcare. Central to this account is what is called the life cycle of events. A clinical action may progress from defined, through planned and ordered, to executed. These modalities of an action are represented as the mood of the act. We then outline the basis of an ontology of organizations, starting from the theory of speech Acts, and apply this ontology to the HL7 RIM. Special attention is given to the sorts of preconditions that must be satisfied for the successful performance of a speech act and to the sorts of entities to which speech acts give rise (e.g. obligations, claims, commitments, etc.). Finally we draw conclusions for the efficient communication and management of medical information and knowledge within and between healthcare organizations, paying special attention to the role that medical documents play in such organizations. (shrink)

There are compelling medical, ethical, and legal arguments that support mandating use of a central institutional review board for the review of clinical trials performed at multiple institutional sites. Progress against serious diseases depends on this.

We examine the influence of word choices on mathematical practice, i.e. in developing definitions, theorems, and proofs. As a case study, we consider Euclid’s and Euler’s word choices in their influential developments of geometry and, in particular, their use of the term ‘polyhedron’. Then, jumping to the twentieth century, we look at word choices surrounding the use of the term ‘polyhedron’ in the work of Coxeter and of Grünbaum. We also consider a recent and explicit conflict of approach between Grünbaum (...) and Shephard on the one hand and that of Hilton and Pedersen on the other, elucidating that the conflict was engendered by disagreement over the proper conceptualization, and so also the appropriate word choices, in the study of polyhedra. (shrink)

To entertain an idea is to take it in, pay attention to it, give it breathing room, dwell with it for a time. The practice of entertaining ideas suggests rumination and meditation, inviting us to think of philosophy as a form of hospitality and a kind of mental theatre. In this collection, organized around key words shared by philosophy and performance, the editors suggest that Shakespeare's plays supply readers, listeners, viewers, and performers with equipment for living. In plays ranging from (...) A Midsummer Night's Dream to King Lear and The Winter's Tale, Shakespeare invites readers and audiences to be more responsive to the texture and meaning of daily encounters, whether in the intimacies of love, the demands of social and political life, or moments of ethical decision. Entertaining the Idea features established and emerging scholars, addressing key words such as role play, acknowledgment, judgment, and entertainment as well as curse and care. The volume also includes longer essays on Shakespeare, Kant, Husserl, and Hegel as well as an afterword by theatre critic Charles McNulty on the philosophy and performance history of King Lear. (shrink)

Semantic role is the actual role a participant plays in some real or imagined situation, apart from the linguistic encoding of those situations. Semantic roles, also known as thematic roles, are one of the oldest classes of constructs in linguistic theory. Semantic roles are used to indicate the role played by each entity in a sentence and are ranging from very specific to very general. Also, semantic roles are useful in natural language processing. They have proved attractive because they provide (...) a way of representing commonalities across different uses of the same predicate or across uses of distinct but semantically related predicates that may be obscured because arguments with certain semantic roles may have various syntactic realisations. Thus they provide a level of abstraction for the statement of generalisations concerning a variety of linguistic phenomena. In particular, argument realisation generalisations are often stated over a thematic hierarchy, a ranking of semantic roles. However, semantic roles have not lived up to their initial promise. It has proved impossible to find a small set of roles that can be applied across all verbs in a language, let alone across languages. Advances in Research on Semantic Roles provide more sustained discussion of the notion of semantic role. It often traces the development of the notion, as well as its place within current linguistic theory. In addition, it introduces several approaches to semantic role inventories, highlighting the similarities and differences among them, and discusses the limitations both of particular approaches and of semantic role approaches in general. Semantic roles continue to be useful in stating linguistic generalisations, and so descriptive, if not theoretical, uses of semantic role labels persist across subfields, including language acquisition, psycholinguistics, and neurolinguistics. (shrink)

The claim that there are nonpurposive functional statements is critically examined by looking at nine translation schemata, several of which are drawn from recent literature. All but one or two fail, suggesting that all functional statements (a) are causal (and not about probabilities or necessary conditions), and (b) have implicit reference to goals. If so, then the possibility of nonpurposive functional statements rests squarely on the possibility of nonpurposive goals.

Severian of Gabala’s homilies and Pseudo-Theodoret’s Quaestiones et responsiones ad Orthodoxos exhibit some notable parallels. Such links show that a marginal current of the Antiochene school was still thriving by the end of the 5th century, i.e. the most probable date of QRO.

A venerable view holds that a border between perception and cognition is built into our cognitive architecture and that this imposes limits on the way information can flow between them. While the deliverances of perception are freely available for use in reasoning and inference, there are strict constraints on information flow in the opposite direction. Despite its plausibility, this approach to the perception-cognition border has faced criticism in recent years. This article develops an updated version of the architectural approach, which (...) I call the dimension restriction hypothesis (DRH). According to DRH, perceptual processes are constrained to compute over a bounded range of dimensions, while cognitive processes are not. This view allows that perception is cognitively penetrable, but places strict limits on the varieties of penetration that can occur. The article argues that DRH enjoys both theoretical and empirical support, and also defends the view against several objections. (shrink)

When Kepler concluded that the orbit of Mars was not a circle, he was led to the belief that the orbit was an oval touching the circle at the apsides and lying within the circle at other points. In the definition of the oval, physical hypotheses played a primary role. Two forces were involved; a tractive force arising from the effect of the solar rays rotating with the sun, and a directing force arising from a natural instinct of the planet (...) itself. The former pushed the planet along the orbit while the latter enabled the planet to steer itself across the stream of the solar vortex in a small epicycle. In adopting this physical theory to determine the oval, Kepler was led into what he himself described as ‘a new labyrinth’. After several attempts to construct the oval, and by progressively eliminating the sources of error from his calculating procedures in order to arrive at an accurate mathematical formulation of the physical hypotheses, he was able to conclude that the oval was inconsistent with the empirical data and the physical theory in need of modification. (shrink)

Insight experiences are sudden, persuasive, and can accompany valuable new ideas in science and art. In this preregistered experiment, we aim to validate a novel visceral and continuous measure of insight problem solving and to test whether real-time and embodied feelings of insight can predict correct solutions. We report several findings. Consistent with recent work, we find a strong positive relationship between Aha moments and accuracy for problems that demand implicit processing. We also found that the intensity of the insight (...) experience further predicted the accuracy of solutions and participants naturally embodied the intensity of their insight experiences by squeezing the dynamometer more tightly. Intriguingly, this unintentional embodiment further predicted the accuracy of solutions. We suggest that the dynamometer complements previous measures by (1) simultaneously capturing both process and feeling in real-time, (2) highlights the value of measuring Aha moments on a continuum of intensity, and (3) firmly establishes that the impulsive feeling of Aha can carry information about the veracity of an idea. We discuss the findings in light of a recent theoretical account of how feelings of insight may act as a heuristic to select ideas from the stream of consciousness. (shrink)

We argue that the trend toward providing users with feasible and actionable explanations of AI decisions—known as recourse explanations—comes with ethical downsides. Specifically, we argue that recourse explanations face several conceptual pitfalls and can lead to problematic explanation hacking, which undermines their ethical status. As an alternative, we advocate that explanations of AI decisions should aim at understanding.

Human clinical research trials, by which corporations, universities, and research scientists bring new drugs, devices, and procedures into the practice and marketplace of medicine, have become a huge business. The National Institutes of Health doubled its spending over the past five years, while in the private sector the top twenty pharmaceutical companies have more than doubled their investment in research and development over a roughly comparable period. To date, some twenty million Americans have participated in clinical research trials that now (...) are as common in the private practice setting as in academia.For many years human clinical trials received relatively little public attention. In the wake of several well-publicized research abuses, Congress created in 1974 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to formulate recommendations to protect human research subjects. The Commission’s 1979 Belmont Report helped to guide the Institutional Review Boards that review the ethics of federally funded research. (shrink)

Human clinical research trials, by which corporations, universities, and research scientists bring new drugs, devices, and procedures into the practice and marketplace of medicine, have become a huge business. The National Institutes of Health doubled its spending over the past five years, while in the private sector the top twenty pharmaceutical companies have more than doubled their investment in research and development over a roughly comparable period. To date, some twenty million Americans have participated in clinical research trials that now (...) are as common in the private practice setting as in academia.For many years human clinical trials received relatively little public attention. In the wake of several well-publicized research abuses, Congress created in 1974 the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research to formulate recommendations to protect human research subjects. The Commission’s 1979 Belmont Report helped to guide the Institutional Review Boards that review the ethics of federally funded research. (shrink)

The abilities to attribute an action to its proper agent and to understand its meaning when it is produced by someone else are basic aspects of human social communication. Several psychiatric syndromes, such as schizophrenia, seem to lead to a dysfunction of the awareness of one’s own action as well as of recognition of actions performed by other. Such syndromes offer a framework for studying the determinants of agency, the ability to correctly attribute actions to their veridical source. Thirty normal (...) subjects and 30 schizophrenic patients with and without hallucinations and/or delusional experiences were required to execute simple finger and wrist movements, without direct visual control of their hand. The image of either their own hand or an alien hand executing the same or a different movement was presented on a TV-screen in real time. The task for the subjects was to discriminate whether the hand presented on the screen was their own or not. Hallucinating and deluded schizophrenic patients were more impaired in discriminating their own hand from the alien one than the non-hallucinating ones, and tended to misattribute the alien hand to themselves. Results are discussed according to a model of action control. A tentative description of the mechanisms leading to action consciousness is proposed. (shrink)

Truth depends in some sense on reality. But it is a rather delicate matter to spell this intuition out in a plausible and precise way. According to the theory of truth-making this intuition implies that either every truth or at least every truth of a certain class of truths has a so-called truth-maker, an entity whose existence accounts for truth. This book aims to provide several ways of assessing the correctness of this controversial claim. This book presents a detailed introduction (...) to the theory of truth-making, which outlines truth-maker relations, the ontological category of truth-making entities, and the scope of a truth-maker theory. The essays brought together here represent the most important articles on truth-making in the last three decades as well as new essays by leading researchers in the field of the theory of truth and of truth-making. (shrink)

This article answers several calls—coming as well from corporate governance practitioners as from corporate governance researchers—concerning the possibility of complying simultaneously with requirements of innovation and ethics. Revealing the long-term orientation as the variable which permits us to link the principal goal of organization, being “survival,” with innovation and ethic, the article devises a framework for incorporating ethics into a company’s processes and strategies for innovation. With the principal goal of organizations being “survival” in the long-term, it is assumed that (...) innovation is necessary in order to realize a going concern. Firms that do not innovate and adapt to rapidly changing business environments are less likely to be sustainable. Thus, it is in a business’ best interests to adopt an innovation process for long-term success. We posit that there are two simultaneous sources of innovation and change that are unavoidable and embedded in the corporate landscape. First, we argue for genetically embedded, Darwinian explanations for adaptations that enable an entity’s survival. This view is combined with more conventional, social science explanations for change. Our new, comprehensive model of the governance of innovation processes hinges on the one hand on an organization’s long-term orientation, which we argue, is not possible without a consideration of an ethical dimension. On the other hand, the model employs, for the first time, the concept of duality, in order to make the positive coexistence of innovation and ethic analytically visible. Guided by this concept the roots of the ethic within innovation are traced from both natural science forces for change, and cultural pressures operating on members of an organization. We present our Integrated Causal Model of Innovation and propose theoretical relationships that will generate numerous avenues for future research in the field, and help managers to reorient their governance strategies. (shrink)

Universal access to health care is still a dream rather than a reality in the United States. This is partly because a rule of rescue, by impelling us to help people in need, urges us to ignore the limits of our health care policies wherever those limits would adversely affect a given individual. As the rule of rescue undermines whatever limits we set on health care entitlements, it can thwart the cost containment so essential to expanding access. Rather than accept (...) unlimited expense, we have thus far declined to universalize health care. The situation is exacerbated by an economic insulation shielding patients and physicians from the costs of care, prompting both to regard health care as free, an unlimited right. To reverse this costly entitlement mentality and place reasonable limits on rescue, patients must exercise greater personal responsibility for the costs of their care by directly experiencing some of the economic consequences of their health care decisions. Several mechanisms are available to accomplish this goal without posing economic barriers to needed care or penalizing people for becoming ill. Keywords: Clinton health plan, rationing, rule of rescue CiteULike Connotea Del.icio.us What's this? (shrink)

Today, economic theory is a mathematical theory, but that was not always the case. Major changes in the ways economists presented their arguments to one another occurred between the late 1930s and the early 1950s; over that period the discipline became mathematized. Professor Weintraub, a noted scholar of the modern history of economic thought, argues that those changes were not merely cosmetic: The mathematical forms of the arguments significantly altered the substance of the arguments. Stabilizing Dynamics is particularly concerned with (...) the ways in which the rich and confusing talk of the 1930s evolved, over a fifteen-year period, into technical analysis of some mathematical structures. The author describes the context for the history of that change, locating it in the broader intellectual currents, and shows how the history of modern economics can be seen as a confluence of several disparate traditions. Historiographically, this book offers one of the first constructivist accounts of modern economic analysis. (shrink)

Interpretation of the classics in political theory seems to go in waves. For a while we had John Locke, the bourgeois thinker. Now we seem to be in a Locke-as-radical-democrat phase. Locke-the-bourgeois had problems of its own, but a radically democratic Locke -- not just the old Locke as liberal democrat but Locke as quasi-Leveller -- strains the interpretative imagination more than most; yet in recent years, several different kinds of argument have been advanced in support of it, both textual (...) and contextual. The most effective argument has proceeded by situating Locke in the context of radical Whig politics in the 1670s and '80s, the struggles over religious toleration and the royal succession, in particular the �Exclusion Crisis� of 1679-81. This contextual argument has been accompanied by various textual interpretations having to do with Locke's conceptions of property, consent, representation, the right of revolution and natural law. Among other things, these are supposed to show that while Locke had nothing explicit to say about the extent of the franchise, the weight of evidence suggests that he would have supported a fairly wide franchise, perhaps even something like the (almost) manhood suffrage advocated by the Levellers (at least according to some, and probably the most convincing, interpretations of their ideas). Most recently, in these pages, Martin Hughes, building on the work of James Tully and Richard Ashcraft in particular, has pushed the argument as far as it can probably go. His argument on taxation and suffrage has provided a motivation here for a wider exploration of Locke's views on representation, consent and the franchise. (shrink)

Suppose you are on a commercial airplane that is flying at 35,000 feet. Next to you sits a man who appears to be sleeping. In fact, this man has been drugged and put upon the plane without his knowledge or consent. He has never flown on a plane before and, indeed, has no idea what an airplane is. Suddenly the man awakes and looks around him. Terrified by the alien environment in which he finds himself, he searches for a door (...) or window from which to make an escape. As luck would have it, he is seated right next to a window exit and he begins to pull the handle that will open the window. You are aware that opening the window exit at this altitude will cause the cabin to quickly depressurize and that this man, you, and probably several other passengers will be sucked out the window to your deaths. You desperately want to stop him from opening the window. Now assume that for some reason it is impossible to prevent him physically from performing the deadly act. Your only option is to rationally persuade him to leave the window exit alone. You cry out to him and, with both hands on the handles, he turns to face you and waits to hear what you have to say. What sort of argument would you make? (shrink)

Short-term or working memory provides temporary storage of information in the brain after an experience and is associated with conscious awareness. Neurons sensitive to the multiple stimulus attributes comprising an experience are distributed within many brain regions. Such distributed cell assemblies, activated by an event, are the most plausible system to represent the WM of that event. Studies with a variety of imaging technologies have implicated widespread brain regions in the mediation of WM for different categories of information. Each kind (...) of WM may thus be expected to involve many brain regions rather than a local, uniquely dedicated set of cells. Neurons in a distributed “cell assembly” may be self-selected by their temporally coherent activations. The process by which this fragmented representation of the recent past is reassembled to accomplish essentially automatic and reliable recognition of a recurrent event constitutes an important problem. One plausible mechanism to achieve the identification of past with previous events would require that the representational system mediating WM must coexist in spatial extent and somehow overlap in temporal activation with cell ensembles registering input from subsequent events. The detection of such a postulated mechanism required an experimental approach which would focus upon spatial patterns of coherent activation while information about different events was stored in WM and retrieved, rather than focusing upon the temporal sequences of activation in localized regions of interest. For this purpose, the familiar delayed matching from sample task was modified. A series of information-free flashes, or “noncontingent probes,” was presented before an initial series of visual information items, the Priming Sample, which were to be held in WM during a Delay Period. A second series of visual information items were then presented, the Matching Sample. The task required detection of any item in the second series which had beenabsentfrom the initial series. Thirty such trials with a particular category of visual information constituted a single task. Several DMS tasks with this standardized design, but with different categories of visual information, were presented within each test session. The information categories included letters of the alphabet, single digit numbers, or faces from a school yearbook. Event-related potentials , were computed from 21 standardized electrode placements, separately for information-free probes and for information items in each interval of the trials within a task. Because each electrode is particularly sensitive to coherent activation of neurons in the immediately underlying brain regions, topographic maps were constructed and interpolated across the surface of the scalp. The momentary fluctuations of the resulting voltage “landscapes” throughout the task were then subjected to quantitative analysis. Distinctive landscapes sometimes persisted for prolonged periods, implying sustained engagement of very large populations of neurons. “Difference landscapes” were constructed by subtraction of topographic maps evoked by noncontingent probes during the Delay Period from maps of probe ERPs before the presentation of the initial information in the Priming Sample. Such probe difference landscapes displayed recurrent high similarity to momentary landscapes elicited during subsequent presentation of the information items in the Matching Sample. It seemed as if the distributed cell assembly continuously engaged by mediation of WM of the diverse attributes of the initial stimuli was being dynamically compared to the ensembles engaged by registration of the subsequent stimuli. Spatial Principal Component Analysis was applied to the sequences of momentary voltage landscapes observed throughout trials of each task. This method sought a small number of spatial patterns with which these large sets of inhomogeneous spatial distributions of voltage could be reconstructed. This is the spatial analog of the reconstruction of local ERPs by temporal principal components, as often described previously. Five Spatial Principal Components were found which accounted for about 90% of the total variance of voltage across the surface of the scalp throughout every task. Theloadings,or distinguishing topographic features, of these SPCs, were highly similar during every cognitive task for every subject. However,factor scores,or relative average contribution to the overall voltage distributions, of the different SPCs varied substantially among subjects between the tasks and momentarily within successive intervals of each task. These five SPCs may reflect coherent activation of huge distributed ensembles of neurons which comprise independent but interacting functional brain subsystems. These subsystems may correspond to basic resources available to individuals for allocation to mediate conscious evaluation of information during cognitive activity, providing a filter to bind together fractionated representations of the past to evaluate the present. (shrink)

The aim of the present study was to describe how registered nurses in nursing homes ensure legal security, good and safe nursing care and uphold the dignity of nursing home residents with severe dementia without violating residents’ integrity. Semi-structured interviews were conducted with 10 charge nurses in a county in central Sweden. The transcribed interviews were examined using manifest and latent content analyses. The manifest analysis identified actual local routines involving coercive treatment and registered nurses’ descriptions of complications and alternative (...) measures. The latent analysis resulted in three themes describing nursing strategies: one with coercive treatment, one with coercive treatment under specific circumstances and one to prevent coercive treatment. Interpretations of legal terms regarding coercive treatment and inadequate gerontological nursing training and understaffing seem to preserve the use of coercive treatment. (shrink)

We analyse the system of ethical review of human research in the Baltic States by introducing the principle of equivalent stringency of ethical review, that is, research projects imposing equal risks and inconveniences on research participants should be subjected to equally stringent review procedures. We examine several examples of non-equivalence or asymmetry in the system of ethical review of human research: (1) the asymmetry between rather strict regulations of clinical drug trials and relatively weaker regulations of other types of clinical (...) biomedical research and (2) gaps in ethical review in the area of non-biomedical human research where some sensitive research projects are not reviewed by research ethics committees at all. We conclude that non-equivalent stringency of ethical review is at least partly linked to the differences in scope and binding character of various international legal instruments that have been shaping the system of ethical review in the Baltic States. Therefore, the Baltic example could also serve as an object lesson to other European countries which might be experiencing similar problems. (shrink)

This article proposes a geostatistical solution for area-to-point spatial prediction (downscaling) taking into account boundary effects. Such effects are often poorly considered in downscaling, even though they often have significant impact on the results. The geostatistical approach proposed in this article considers two types of boundary conditions (BC), that is, a Dirichlet-type condition and a Neumann-type condition, while satisfying several critical issues in downscaling: the coherence of predictions, the explicit consideration of support differences, and the assessment of uncertainty regarding the (...) point predictions. An updating algorithm is used to reduce the computational cost of area-to-point prediction under a given BC. In a case study, area-to-point prediction under a Dirichlet-type BC and a Neumann-type BC is illustrated using simulated data, and the resulting predictions and error variances are compared with those obtained without considering such conditions. (shrink)

Background: Breaches of publication ethics such as plagiarism, data fabrication and redundant publication are recognised as forms of research misconduct that can undermine the scientific literature. We surveyed journal editors to determine their views about a range of publication ethics issues. Methods: Questionnaire sent to 524 editors-in-chief of Wiley-Blackwell science journals asking about the severity and frequency of 16 ethical issues at their journals, their confidence in handling such issues, and their awareness and use of guidelines. Results: Responses were obtained (...) from 231 editors (44%), of whom 48% edited healthcare journals. The general level of concern about the 16 issues was low, with mean severity scores of <1 (on a scale of 0–3) for all but one. The issue of greatest concern (mean score 1.19) was redundant publication. Most editors felt confident in handling the issues, with <15% feeling “not at all confident” for all but one of the issues (gift authorship, 22% not confident). Most editors believed such problems occurred less than once a year and >20% of the editors stated that 12 of the 16 items never occurred at their journal. However, 13%–47% did not know the frequency of the problems. Awareness and use of guidelines was generally low. Most editors were unaware of all except other journals’ instructions. Conclusions: Most editors of science journals seem not very concerned about publication ethics and believe that misconduct occurs only rarely in their journals. Many editors are unfamiliar with available guidelines but would welcome more guidance or training. (shrink)

Several prominent cases have recently highlighted tension between the interests of individuals and those of the broader population in gaining access to health care resources. The care of Helga Wanglie, an elderly woman whose family insisted on continuing life support long after she had lapsed into a persistent vegetative state, cost approximately $750,000, the majority of which was paid by a Medi-gap policy purchased from a health maintenance organization. Similarly, Baby K was an anencephalic infant whose mother, believing that all (...) life is precious regardless of its quality, insisted that the hospital where her daughter was born provide mechanical ventilation, including intensive care, whenever respiratory distress threatened her life. Over the hospital's objections, courts ruled that aggressive care must be provided. Much of Baby K's care was covered by her mother's HMO policy. In the 1993 case of Fox v. HealthNet, a jury awarded $89 million to the family of a woman whose HMO had refused, as experimental, coverage for autologous bone marrow transplant in treating her advanced breast cancer. (shrink)