In the era of precision medicine and expanding health information technologies, large representative datasets are considered necessary for addressing health inequities. Partially in response to gro...

In this article, the main definitions and differentiation concepts of neutrosophic fuzzy environment will be reviewed. This article will introduce an analytical methodology for solving the second-order linear ordinary differential problem with neutrosophic fuzzy boundary values, this analysis will be under generalized Hukuhara differentiability to show the analytical solutions from a different point of view for the uncertain system, some of these solutions may be decreasing in uncertainty or maybe reflecting the behavior of some real-world systems better. Some applications and (...) numeral examples will be solved to show the behavior of the solution. (shrink)

Between History and Philosophy is the first book-length study in English to focus on the rhetorical functions and forms of anecdotal narratives in early China. Edited by Paul van Els and Sarah A. Queen, this volume advances the thesis that anecdotes—brief, freestanding accounts of single events involving historical figures, and occasionally also unnamed persons, animals, objects, or abstractions—served as an essential tool of persuasion and meaning-making within larger texts. Contributors to the volume analyze the use of anecdotes from the (...) Warring States Period to the Han Dynasty, including their relations to other types of narrative, their circulation and reception, and their central position as a mode of argumentation in a variety of historical and philosophical literary genres. (shrink)

This paper introduces the first English-language book-length study to focus on the rhetorical function of anecdotal narratives across several literary genres of early China. In this volume we seek to clarify the nature and function of early Chinese anecdotes by raising the following questions: What are their characteristic features? What are their generic boundaries, that is to say, how do they relate to other types of narrative? What degree of historical authenticity do they display? How malleable were the stories? What (...) different framing techniques did authors use to fit stock anecdotes into larger narrative contexts? What was the rhetorical power of anecdotes when used in argumentation? How does the early Chinese preference for using anecdotes in argumentation differ from modes of argumentation preferred in other eras and cultures? In addressing these and other questions, this book will advance the idea that anecdotes were an essential rhetorical tool that early Chinese writers used effectively to persuade their audience of one or another point of view. (shrink)

The increased use of human biological material for cell-based research and clinical interventions poses risks to the privacy of patients and donors, including the possibility of re-identification of individuals from anonymized cell lines and associated genetic data. These risks will increase as technologies and databases used for re-identification become affordable and more sophisticated. Policies that require ongoing linkage of cell lines to donors’ clinical information for research and regulatory purposes, and existing practices that limit research participants’ ability to control what (...) is done with their genetic data, amplify the privacy concerns. (shrink)

Picking up the question of what FLaK might be, this editorial considers the relationship between openness and closure in feminist legal studies. How do we draw on feminist struggles for openness in common resources, from security to knowledge, as we inhabit a compromised space in commercial publishing? We think about this first in relation to the content of this issue: on image-based abuse continuums, asylum struggles, trials of protestors, customary justice, and not-so-timely reparations. Our thoughts take us through the different (...) ways that openness and closure work in struggles against violence, cruel welcomes, and re-arrangements of code and custom. Secondly, we share some reflections on methodological openness and closure as the roundtable conversation on asylum, and the interview with Riles, remind us of #FLaK2016 and its method of scattering sources as we think about how best to mix knowledges. Thirdly, prompted by the FLaK kitchen table conversations on openness, publishing and ‘getting the word out’, we respond to Kember’s call to ‘open up open access’. We explain the different current arrangements for opening up FLS content and how green open access, the sharedit initiative, author request and publisher discretion present alternatives to gold open access. Finally drawing on Franklin and Spade, we show how there are a range of ‘wench tactics’—adapting gifts, stalling and resting—which we deploy as academic editors who are trying to have an impact on the access, use and circulation of our journal, even though we do not own the journal we edit. These wench tactics are alternatives to the more obvious or reported tactic of resignation, or withdrawing academic labour from editing and reviewing altogether. They help us think about brewing editorial time, what ambivalence over our 25th birthday might mean, and how to inhabit painful places. In this, we respond in our own impure, compromised way to da Silva’s call not to forget the native and slave as we do FLaK, and repurpose shrapnel, in our common commitments. (shrink)

Macrocephaly is present in about 2–5% of the general population. It can be found as an isolated benign trait or as part of a syndromic condition. Brain overgrowth has been associated with neurodevelopmental disorders such as autism during the first year of life, however, evidence remains inconclusive. Furthermore, most of the studies have involved pathological or high-risk populations, but little is known about the effects of brain overgrowth on neurodevelopment in otherwise neurotypical infants. We investigated the impact of brain overgrowth (...) on basic perceptual learning processes during the first year of life. We recorded high density electroencephalograms in 116 full-term healthy infants aged between 3 and 11 months, 35 macrocephalic and 81 normocephalic classified according to the WHO head circumference norms. We used an adapted oddball paradigm, time-frequency analyses, and auditory event-related brain potentials to investigate differences between groups. We show that brain overgrowth has a significant impact on repetition effects and change detection response in the 10–20 Hz frequency band, and in N450 latency, suggesting that these correlates of sensorial learning processes are sensitive to brain overgrowth during the first year of life. (shrink)

Research has shown high levels of housing precarity among government-assisted refugees connected to difficult housing markets, limited social benefits, and other social and structural barriers to positive settlement. The COVID-19 pandemic has likely exacerbated this precarity. Research to date demonstrates the negative consequences of the COVID-19 pandemic for refugees and low-income households, including both health-related issues and economic challenges, that may exacerbate their ability to obtain affordable, suitable housing. In this context, we examined Syrian government-assisted refugees’ experiences during the pandemic, (...) asking: how the COVID-19 pandemic has impacted Syrian refugees’ experiences of housing stability. To examine this issue, we interviewed 38 families in Calgary, London, and Fredericton. Using a qualitative descriptive methodology for analysis and interpretation, we found the liminality of settling as a GAR has been compounded by isolation, further economic loss, and new anxieties during the pandemic. Ultimately, for many participants, the pandemic has thwarted their housing stability goals and decreased their likelihood of improving their housing conditions. Based on our findings, we discuss potential policy and practice relevant solutions to the challenges faced by refugees in Canada during the pandemic and likely beyond. (shrink)

In Cameroon, a monumental “statue of liberty” is made from scrap metal. In Congo, a thriving popular music incorporates piercing screams and carnal dances. When these and other instantiations of the aesthetics of Africa and its diasporas are taken into account, how are ideas of beauty reconfigured? Scholars and artists take up that question in this invigorating, lavishly illustrated collection, which includes more than one hundred color images. Exploring sculpture, music, fiction, food, photography, fashion, and urban design, the contributors engage (...) with and depart from canonical aesthetic theories as they demonstrate that beauty cannot be understood apart from ugliness. Highlighting how ideas of beauty are manifest and how they mutate, travel, and combine across time and distance, continental and diasporic writers examine the work of a Senegalese sculptor inspired by Leni Riefenstahl’s photographs of Nuba warriors; a rich Afro-Brazilian aesthetic incorporating aspects of African, Jamaican, and American cultures; and African Americans’ Africanization of the Santería movement in the United States. They consider the fraught, intricate spaces of the urban landscape in postcolonial South Africa; the intense pleasures of eating on Réunion; and the shockingly graphic images on painted plywood boards advertising “morality” plays along the streets of Ghana. And they analyze the increasingly ritualized wedding feasts in Cameroon as well as the limits of an explicitly “African” aesthetics. Two short stories by the Mozambican writer Mia Couto gesture toward what beauty might be in the context of political failure and postcolonial disillusionment. Together the essays suggest that beauty is in some sense future-oriented and that taking beauty in Africa and its diasporas seriously is a way of rekindling hope. Contributors. Rita Barnard, Kamari Maxine Clarke, Mia Couto, Mark Gevisser, Simon Gikandi, Michelle Gilbert, Isabel Hofmeyr, William Kentridge, Dominique Malaquais, Achille Mbembe, Cheryl-Ann Michael, Celestin Monga, Sarah Nuttall, Patricia Pinho, Rodney Place, Els van der Plas, Pippa Stein, Françoise Vergès. (shrink)

In Cameroon, a monumental "statue of liberty" is made from scrap metal. In Congo, a thriving popular music incorporates piercing screams and carnal dances. When these and other instantiations of the aesthetics of Africa and its diasporas are taken into account, how are ideas of beauty reconfigured? Scholars and artists take up that question in this invigorating, lavishly illustrated collection, which includes more than one hundred color images. Exploring sculpture, music, fiction, food, photography, fashion, and urban design, the contributors engage (...) with and depart from canonical aesthetic theories as they demonstrate that beauty cannot be understood apart from ugliness. Highlighting how ideas of beauty are manifest and how they mutate, travel, and combine across time and distance, continental and diasporic writers examine the work of a Senegalese sculptor inspired by Leni Riefenstahl's photographs of Nuba warriors; a rich Afro-Brazilian aesthetic incorporating aspects of African, Jamaican, and American cultures; and African Americans' Africanization of the Santería movement in the United States. They consider the fraught, intricate spaces of the urban landscape in postcolonial South Africa; the intense pleasures of eating on Réunion; and the shockingly graphic images on painted plywood boards advertising "morality" plays along the streets of Ghana. And they analyze the increasingly ritualized wedding feasts in Cameroon as well as the limits of an explicitly "African" aesthetics. Two short stories by the Mozambican writer Mia Couto gesture toward what beauty might be in the context of political failure and postcolonial disillusionment. Together the essays suggest that beauty is in some sense future-oriented and that taking beauty in Africa and its diasporas seriously is a way of rekindling hope. Contributors. Rita Barnard, Kamari Maxine Clarke, Mia Couto, Mark Gevisser, Simon Gikandi, Michelle Gilbert, Isabel Hofmeyr, William Kentridge, Dominique Malaquais, Achille Mbembe, Cheryl-Ann Michael, Celestin Monga, Sarah Nuttall, Patricia Pinho, Rodney Place, Els van der Plas, Pippa Stein, Françoise Vergès. (shrink)

En este artículo se desarrolla el marco conceptual del “contextualismo sexual” para el estudio de las variables relacionadas con el sexo en la investigación biomédica. El contextualismo sexual ofrece una alternativa a los enfoques sexuales binarios y esencialistas del estudio del sexo como variable biológica. Específicamente, el contextualismo sexual reconoce el pluralismo y la especificidad contextual que tienen las operacionalizaciones de “sexo” a través de la investigación experimental de laboratorio. A la luz de recientes normativas para la consideración del sexo (...) como variable biológica, el contextualismo sexual ofrece una guía constructiva a los/as investigadores/as biomédicos/as para abordar la variación biológica relacionada con el sexo. En tanto alternativa y crítica al esencialismo binario del sexo biológico, el contextualismo sexual contribuye a los debates actuales en filosofía de la biología, estudios feministas de la ciencia y ontología social en torno a la construcción de categorías de la diferencia sexual/genérica en la investigación científica. (shrink)

It is common to interpret Maimonides as emphasizing the unknowability of God’s essence. In this paper, Sarah Pessin asks us to supplement this interpretation with the additional sense that God’s essence is also knowable for Maimonides. Analyzing Maimonides’ treatment of Exodus 33-34 and his treatment of the various ways of knowing and not knowing “God’s Face” and “God’s Back,” Pessin identifies “philosophical wonder” as a special state in which philosophers and prophets apprehend nature in such a way as to (...) be filled with an awareness of God’s presence in the universe. After presenting passages of the Guide of the Perplexed which beckon to God’s knowability, she goes on to introduce “hylomorphic apophasis”—the idea that God, for Maimonides, is simultaneously manifest in and obscured by the materiality of nature. The essay ends with a consideration of Maimonides’ analysis of a Rabbinic verse about God’s wrapping himself in a prayer shawl. (shrink)

When asked to identify objects having unique shapes and colors among other objects, English speakers often produce redundant color modifiers (“the red circle”) while Spanish speakers produce them less often (“el circulo (rojo)”). This cross‐linguistic difference has been attributed to a difference in word order between the two languages, under the incremental efficiency hypothesis (Rubio‐Fernández, Mollica, & Jara‐Ettinger, 2020). However, previous studies leave open the possibility that broad language differences between English and Spanish may explain this cross‐linguistic difference such that (...) English speakers may generally produce more modifiers than Spanish speakers, including redundant ones, irrespective of word order. Here, we test the incremental efficiency hypothesis in a language production task crossing language (English, Spanish) with modifier type (color, number). Critically, number words occur on the same side of the noun in both English and Spanish. If broad language differences are responsible for the higher rate of color word production in English compared to Spanish, then the same effect should hold for number words. In contrast, the incremental efficiency hypothesis predicts an interaction between language and modifier type, due to different ordering for color words but identical ordering for number words. Our pre‐registered analyses offer strong support for the incremental efficiency hypothesis, demonstrating how seemingly small differences in language can cause us to describe the world in surprisingly different ways. (shrink)

Introducción: El examen estatal escrito evalúa la competencia del egresado y debe cumplir los requisitos de su confección y de su análisis informar las deficiencias en el proceso docente educativo para su perfeccionamiento. Objetivo: Caracterizar el examen estatal ordinario escrito y los resultados obtenidos en la Facultad de Estomatología. Camagüey durante el período 2011-2012. Métodos: Se realizó un estudio descriptivo del examen estatal ordinario escrito aplicado a 146 estudiantes. Se elaboró una base de datos con las calificaciones obtenidas, índice académico (...) y una guía con las variables tipo de examen, de preguntas, nivel de asimilación, claridad de formulación, correspondencia con los objetivos de la carrera, clave de calificación y cumplimiento de los criterios de Guilbert, analizados por grupo de expertos. Resultados: En los resultados se aproximó la nota de los excelentes (27,4 %) con el índice académico de los altos rendimientos (28,1 %). La mediana general fue de 86,3. Los temas más explorados fueron Endodoncia (18,8 %), Prótesis y Odontopediatría (10,4 %). Las preguntas con más valor fueron de temas curativos. El nivel de asimilación fue reproductivo y el 35,4 % de preguntas tipo selección múltiple complemento agrupado. Existieron dificultades de diseño del examen y autopreparación de los estudiantes. Conclusiones: Los resultados se aproximaron a los rendimientos académicos. No hubo equidad entre el número, valor de las preguntas por temas y nivel de asimilación. Los errores se asociaron en frecuencia al diseño y redacción de algunas preguntas, insuficiente estudio y en menor grado a la falta de sistematicidad en el proceso docente, que permitieron determinar las deficiencias para su intervención. Introduction: The State written exam evaluates the competence of seniors and must meet the requirements of its preparation and analysis in order to report deficiencies in the educational teaching process for its further development. Objective: To characterize the written regular state exam and the results obtained at the Faculty of Stomatology. Camaguey during the period of 2011-2012. Methods: A descriptive study of the written regular state exam was conducted to 146 students. A data base was developed with the grades obtained, academic index and a guide with the exam- type variables, questions, level of assimilation, clarity of formulation, correspondence with the objectives of the career, key qualification and compliance with the criteria of Guilbert, all analyzed by groups of experts. Results: In the results the excellent notes (27.4%) approached to the academic index of high yield (28.1%). The general average was 86,3. The most explored themes were Endodontics (18.8%), Prosthesis and Pediatric Odontology (10.4%). healing topics were the questions with more value. The level of assimilation was reproductive and 35.4% of multiple choice type questions complement clustered. There were difficulties according to the test design and the students' self study. Conclusions: The results were close to academic performance. There was no equality between the number, value of the questions by topic and level of assimilation. Errors were often associated with the design and wording of some questions, insufficient study and in a lesser extent to the lack of systematic fashion in the teaching process, which allowed to determine deficiencies for its intervention. (shrink)

Fundamento: La ampliación de matrícula con la diversidad de vías de ingreso ha constituido un reto en la educación médica y la evaluación de graduación implica la certificación de la competencia de los egresados, por eso se hace necesario analizar los resultados obtenidos en estas etapas. Objetivo: Comparar los resultados de los ejercicios prácticos, teóricos y notas finales obtenidas por los estudiantes presentados a Exámenes Estatales Ordinarios de los cursos del 2006 al 2012 de la Facultad de Estomatología en la (...) Universidad de Ciencias Médicas de Camagüey. Métodos: Se realizó una investigación descriptiva con 410 estudiantes presentados a exámenes estatales ordinarios en el período 2006-2012. Se clasificaron los grupos con menos o más de 40 estudiantes por cursos. Se obtuvieron las calificaciones de cada ejercicio y nota final estatal por cursos. Se utilizó el método porcentual, media aritmética y mediana obtenida en cada curso. Resultados: Los cursos del 2006-2009 sumaron 99 estudiantes y en los cursos del 2009-2012 se incrementaron hasta 311 educandos. En los exámenes estatales prácticos, los grupos pequeños obtuvieron calificación media de 99,2 y una mediana de 99 y 100; en los grupos numerosos las calificaciones disminuyeron hasta llegar a una media de 93 y una mediana de 95. En los exámenes teóricos, en los tres primeros cursos la media de calificación fue 83,5 y en el grupo numeroso de 83,7. Conclusiones: En los resultados se mantiene la calidad de la base científica de la actuación en todos los cursos, pero ha disminuido la del desempeño en los cursos con incremento de estudiantes. Background: The extension of registration with the diversity of entrance ways has been a challenge in medical education. Graduation assessment involves the certification of the competence among seniors, therefore it is necessary to analyze the results obtained in these stages. Objective: To compare the results of theoretical, practical exercises and final notes obtained by the students submitted to Regular State examinations in the courses from 2006 to 2012 of the Dentistry Faculty at the Medical Sciences University of Camaguey. Methods: A descriptive research with 410 students submitted to Regular State examination was conducted in the period of 2006 to 2012. The groups were classified with less or more than 40 students per courses. The ratings of each exercise and state final note by courses were obtained. The methods used in each course were the percentage method, arithmetic mean and median obtained. Results: The courses from 2006 to 2009 totaled 99 students and in the courses from 2009 to 2012 the number of students increased up to 311. In the State practical tests small groups obtained qualification average of 99.2 and a median of 99 and 100; numerous groups' ratings fell to an average of 93 and an average of 95. In the theoretical tests, in the first three courses the average rating was 83.5 and in the large group it was 83.7. Conclusions: The results maintain the quality of the scientific basis of the performance in all courses, but the performance in courses with students increase has declined. (shrink)

Este artículo pretende analizar, el proceso de mercantilización y comercialización del carnaval de Ouro Preto, Minas Gerais (MG), Brasil, en el cual la juventud y las características que le son socialmente atribuidas emergen en un escenario festivo, influenciado principalmente por la industria del entretenimiento. Para ello, se realizó un estudio del carnaval de esta ciudad del año 2009, desde un enfoque cualitativo, combinando las investigaciones bibliográfica, documental y de campo. Sin desconsiderar las múltiples posibilidades de apropiación de los sujetos en (...) el diverso y plural tiempo-espacio de la fiesta, se identificó que las variadas formas específicas de ser joven, sus looks y estilos de vivenciar el carnaval, son el principal producto a ser vendido en el mercado de la diversión y del entretenimiento. La fiesta, que hasta hace muy poco tiempo ocurría en las calles de la ciudad, con posibilidad de participación gratuita, se transforma así en mega-producciones pagadas, privadas y destinadas principalmente al público joven. (shrink)

Los códigos éticos humanos no son coherentes en su diseño ni tampoco tienen una distribución universal. Por lo tanto, la imposible universalidad ni completitud de los sistemas éticos para la inteligencia artificial es algo evidente que tan sólo fue apuntado someramente por el estudio reciente del MIT. Al tener toda ética un matiz cultural inequívoco, y también incluir grados de interpretación en sus principios. Al mismo tiempo se produce un problema formal: un sistema de IA no siempre cuenta con suficientes (...) datos ni tiempo óptimo para procesar una situación, por lo que un factor de azar ético debe tenerse en cuenta en el diseño de tales sistemas. (shrink)

Los métodos productivos de enseñanza preparan a los estudiantes para resolver problemas semejantes a los que se enfrentarán en el ejercicio laboral. Este trabajo tiene como objetivo fundamentar la pertinencia de la utilización del caso clínico como herramienta didáctica para la enseñanza en las ciencias básicas biomédicas, mediante un sistema de tareas para abordar los contenidos del tema Fisiología de la sangre de la asignatura Sangre y Sistema Inmune de la carrera de medicina. El caso clínico permite la vinculación de (...) las ciencias básicas biomédicas con las ciencias clínicas. Su utilización contribuye a la aproximación del estudiante de las ciencias básicas al estudio de estas durante su formación médica. El aprendizaje se logra a lo largo del proceso de resolución del mismo, se estimula la incorporación de conceptos necesarios para resolver el problema y se aprende un método para abordar situaciones en la práctica. Se elaboró un sistema de tareas y preguntas derivadas del problema profesional síndrome anémico. El problema docente se basó en un artículo médico que expone un caso de lesiones por empalamiento que produjo un gran sangramiento en un individuo. Se elaboraron preguntas problémicas relacionadas con la fisiología de la sangre y el tratamiento que recibió el paciente con eritropoyetina, factores de la coagulación y soluciones cristaloides en sustitución de la sangre. Se incluyó una pregunta que aborda un conflicto ético para sistematizar los conocimientos adquiridos en la asignatura Sociedad y Salud II. Productive teaching methods train students to solve problems similar to those they will face in their work life. The objective of the paper is to argue pertinence in the use of the clinical case as a didactic tool in biomedical basic sciences teaching by means of a task system that deals with the contents of the Blood Physiology subject in the Blood and Immune System subject matter of the medicine degree. Clinical cases enable the link between biomedical basic sciences and clinical sciences. Their use contributes to basic sciences students' approach to the study of the latter during their medical training. Learning is achieved through its solving process; the introduction of necessary problem-solving concepts is encouraged and a method to deal with in-practice situations is learned. A task and questions system derived from the anemic syndrome professional problem was made. The teaching problem was based on a medical article which presents a case of an individual who suffered impaling injuries which caused a great bleeding. Problem questions related to blood physiology and to the erythropoietin-based treatment the patient received, coagulation factors and crystalloid fluids used as blood substitutes, were prepared. It was included a question that deals with an ethical conflict in order to systematize the knowledge acquired in the Society and Health II subject matter. (shrink)

Traditional philosophical discussions of knowledge have focused on the epistemic status of full beliefs. In this book, Moss argues that in addition to full beliefs, credences can constitute knowledge. For instance, your .4 credence that it is raining outside can constitute knowledge, in just the same way that your full beliefs can. In addition, you can know that it might be raining, and that if it is raining then it is probably cloudy, where this knowledge is not knowledge of propositions, (...) but of probabilistic contents. -/- The notion of probabilistic content introduced in this book plays a central role not only in epistemology, but in the philosophy of mind and language as well. Just as tradition holds that you believe and assert propositions, you can believe and assert probabilistic contents. Accepting that we can believe, assert, and know probabilistic contents has significant consequences for many philosophical debates, including debates about the relationship between full belief and credence, the semantics of epistemic modals and conditionals, the contents of perceptual experience, peer disagreement, pragmatic encroachment, perceptual dogmatism, and transformative experience. In addition, accepting probabilistic knowledge can help us discredit negative evaluations of female speech, explain why merely statistical evidence is insufficient for legal proof, and identify epistemic norms violated by acts of racial profiling. Hence the central theses of this book not only help us better understand the nature of our own mental states, but also help us better understand the nature of our responsibilities to each other. (shrink)

This paper develops a precise understanding of the thesis of moral encroachment, which states that the epistemic status of an opinion can depend on its moral features. In addition, I raise objections to existing accounts of moral encroachment. For instance, many accounts fail to give sufficient attention to moral encroachment on credences. Also, many accounts focus on moral features that fail to support standard analogies between pragmatic and moral encroachment. Throughout the paper, I discuss racial profiling as a case study, (...) arguing that moral encroachment can help us identify one respect in which racial profiling is epistemically problematic. (shrink)

The Ethics of Need: Agency, Dignity, and Obligation argues for the philosophical importance of the notion of need and for an ethical framework through which we can determine which needs have moral significance. In the volume, Sarah Clark Miller synthesizes insights from Kantian and feminist care ethics to establish that our mutual and inevitable interdependence gives rise to a duty to care for the needs of others. Further, she argues that we are obligated not merely to meet others’ needs (...) but to do so in a manner that expresses "dignifying care," a concept that captures how human interactions can grant or deny equal moral standing and inclusion in a moral community. She illuminates these theoretical developments by examining two cases where urgent needs require a caring and dignifying response: the needs of the elderly and the needs of global strangers. Those working in the areas of feminist theory, women’s studies, aging studies, bioethics, and global studies should find this volume of interest. (shrink)

Studies on end-of-life care reveal different practices regarding withholding and/or withdrawing life-sustaining treatments between countries and regions. Available data about physicians’ practices regarding end-of-life care in ICUs in Egypt is scarce. This study aimed to investigate physicians’ attitudes toward end-of-life care and the reported practice in adult ICUs in Ain Shams University Hospitals, Cairo, Egypt. 100 physicians currently working in several ICU settings in Ain Shams University Hospitals were included. A self-administered questionnaire was used for collection of data. Most of (...) the participants agreed to implementation of “do not resuscitate” orders and applying pre-written DNR orders, while only 13% almost always/often order DNR for terminally-ill patients. 52% of the participants agreed to usefulness of limiting life-sustaining therapy in some cases, but they expressed fear of legal consequences. 47% found withholding life-sustaining treatment is more ethical than its withdrawal. 16% almost always/often withheld further active treatment but continued current ones while only 6% almost always/often withdrew active therapy for terminally-ill patients. The absence of legislation and guidelines for end-of-life care in ICUs at Ain Shams University Hospitals was the main influential factor for the dissociation between participants’ attitudes and their practices. Therefore, development of a consensus for end-of-life care in ICUs in Egypt is mandatory. Also, training of physicians in ICUs on effective communication with patients’ families and surrogates is important for planning of limitation of life-sustaining treatments. (shrink)

An assessment of America's preference for "extra-large" shares examples ranging from mega churches and breast augmentation to landfills and mega-malls, in a cautionary report that reveals some of the consequences of these choices.

Background Researchers are required to determine whether a person has capacity to consent to a research study before they are able to participate. The Mental Capacity Act and accompanying Code of Practice for England and Wales provide some guidance on this process, but researchers have identified that it can be difficult to determine capacity to consent when a person has complex cognitive or communication needs. This study aimed to understand the experiences and opinions of researchers who recruit people with dementia (...) to research projects, to inform the future development of training resources. Methods A mixed method, cross-sectional, electronic survey was circulated via social media and research networks in England and Wales. The survey remained open for ten weeks and included open and closed questions exploring respondents’ confidence in determining capacity in the context of recruiting people with dementia to consent, their views on training and support they have experienced and their suggestions for future training and support needs. Results 60 respondents completed the survey from across England and Wales. Although 75% of respondents had experience of determining capacity to consent with people with dementia to research, only 13% rated themselves as feeling ‘very confident’ in this. Qualitative content analysis of open responses led to the generation of six themes, explaining researchers’ confidence, competence and future training needs in this area: (1) Researcher uncertainties, (2) Lack of time, (3) Balancing information complexity with accessibility, (4) Gatekeepers, (5) Existing enablers and (6) Envisioning future training. Conclusions Researchers would benefit from specific training in undertaking conversations around consent with people with dementia. People with dementia may have fluctuating capacity, and despite support from caregivers, researchers have little practical guidance on methods of determining a person’s ability to understand or appreciate the information they have provided during the consent process. Given the development of large complex trials within dementia research, there is an urgency to develop specific and practical guidance and training for researchers working with people with dementia and their families. (shrink)

A practical judgement is one which enjoys an internal, necessary relation to subsequent action or intention, and which can serve as a sufficient explanation of such action or intention. Does the phenomenon of weakness of will show that deliberation does not characteristically issue in such practical judgements? The author argues that the possibility of akrasia does not threaten the view that we make practical judgements, when the latter thesis is properly understood. Indeed, the author suggests that the alleged possibility of (...) global akrasia actually supports the practical‐judgement model over what she considers its main rival, a kind of ‘Humean externalism’ about practical reason. (shrink)

Coming to Life: Philosophies of Pregnancy, Childbirth and Mothering is a superlative collection of essays that does what too few scholarly works have dared: it takes seriously the philosophical significance of women’s lived experience. Every woman, regardless of her own reproductive story, is touched by the often restrictive beliefs and norms governing discourses about pregnancy, childbirth and mothering. Thus the concerns of this anthology are relevant to all women and central to any philosophical project that takes women’s lives seriously. In (...) this volume 16 authors- including both established feminists and some of today’s most innovative new scholars- engage in sustained reflection on the experiences of pregnancy, childbirth and mothering, and on the beliefs, customs, and political institutions by which those experiences are informed. Many of the topics in this collection, though familiar, are here taken up in a new way: contributors think beyond the traditional pro-choice/pro-life dichotomy, speak to the manifold nature of mothering by considering the experiences of adoptive mothers and birthmothers, and upend the belief that childrearing practices must be uniform despite psycho-sexual differences in children. Many chapters reveal the radical shortcomings of conventional philosophical wisdom by placing trenchant assumptions about subjectivity, gender, power and virtue in dialogue with women’s experience. The volume is diverse both in its content and in its scholarly approach; certain of the essays are informed by their authors’ own experiences, others draw from extant narratives; many engage such canonical thinkers as Plato, Aristotle, Nietzsche and Heidegger, while others draw from the works of contemporary feminists including Sara Ruddick, Iris Marion Young, Virginia Held, Julia Kristeva and Luce Irigaray. All readers, regardless of their philosophical training and commitments, will find much to appreciate in this volume. (shrink)

Introduction: The humanities enrich and transform the practice of medicine. What remains to be seen, however, is how best to integrate humanities into the medical curriculum to optimize both educational and patient-related outcomes. The present study considers the structure of an innovative student-driven humanities curriculum and seeks to understand its strengths and limitations, as well as make recommendations for improvement. Methods: The Penn State College of Medicine, University Park Regional Campus uses an inquiry-based approach to education, whereby students are responsible (...) for creating learning objectives in four core pillars of exploration: Foundational Science, Clinical Science, Health Systems Science, and Health Humanities. This study explores student-derived humanities learning objectives (HLO) across four years of the curriculum. Results: 420 HLOs met criteria for analysis and were coded as instrumental (developing direct clinical skill), non-instrumental (non-skill based), or both. Of these, 125 (30%) were instrumental, 239 (57%) were non-instrumental, and 56 (13%) were coded as both. Most instrumental HLO centered around communication skills. Non-instrumental HLO most commonly focused on bearing witness and critiquing a particular experience within a social and/or political context. Conclusions: Findings from this study contribute to the development of a humanities curriculum in a student-directed learning program. Non-instrumental HLO lacked a theoretical framework to guide student’s investigations to a deeper level of analysis. Student-directed learning offers many strengths, but can be enhanced through external direction from humanities trained faculty, particularly given that many medical students have a limited humanities background. (shrink)

Traditionally, discussions of moral participation – and in particular moral agency – have focused on fully formed human actors. There has been some interest in the development of morality in humans, as well as interest in cultural differences when it comes to moral practices, commitments, and actions. However, until relatively recently, there has been little focus on the possibility that nonhuman animals have any role to play in morality, save being the objects of moral concern. Moreover, when nonhuman cases are (...) considered as evidence of moral agency or subjecthood, there has been an anthropocentric tendency to focus on those behaviors that inform our attributions of moral agency to humans. For example, some argue that the ability to evaluate the principles upon which a moral norm is grounded is required for full moral agency. Certainly, if a moral agent must understand what makes an action right or wrong, then most nonhuman animals would not qualify (and perhaps some humans too). However, if we are to understand the evolution of moral psychology and moral practice, we need to turn our attention to the foundations of full moral agency. We must first pay attention to the more broadly normative practices of other animals. Here, we begin that project by considering evidence that great apes and cetaceans participate in normative practices. (shrink)

Existing discussions of legal proof address a host of apparently disparate questions: What does it take to prove a fact beyond a reasonable doubt? Why is the reasonable doubt standard notoriously elusive, sometimes considered by courts to be impossible to define? Can the standard of proof by a preponderance of the evidence be defined in terms of probability thresholds? Why is statistical evidence often insufficient to meet the burden of proof? -/- This paper defends an account of proof that addresses (...) each of these questions. Where existing theories take a piecemeal approach to these puzzles, my theory develops an insight that unifies them—namely, the thesis that legal proof requires knowledge. Although this thesis may seem radical at first, I answer several common objections to it, and I argue that it does better than several competing accounts when it comes to making sense of our intuitions about what legal proof requires. (shrink)

This paper motivates and develops a novel semantics for several epistemic expressions, including possibility modals and indicative conditionals. The semantics I defend constitutes an alternative to standard truth conditional theories, as it assigns sets of probability spaces as sentential semantic values. I argue that what my theory lacks in conservatism is made up for by its strength. In particular, my semantics accounts for the distinctive behavior of nested epistemic modals, indicative conditionals embedded under probability operators, and instances of constructive dilemma (...) containing epistemic vocabulary. (shrink)

This paper argues that just as full beliefs can constitute knowledge, so can properties of your credence distribution. The resulting notion of probabilistic knowledge helps us give a natural account of knowledge ascriptions embedding language of subjective uncertainty, and a simple diagnosis of probabilistic analogs of Gettier cases. Just like propositional knowledge, probabilistic knowledge is factive, safe, and sensitive. And it helps us build knowledge-based norms of action without accepting implausible semantic assumptions or endorsing the claim that knowledge is interest-relative.

Suppose some person 'A' sets out to accomplish a difficult, long-term goal such as writing a passable Ph.D. thesis. What should you believe about whether A will succeed? The default answer is that you should believe whatever the total accessible evidence concerning A's abilities, circumstances, capacity for self-discipline, and so forth supports. But could it be that what you should believe depends in part on the relationship you have with A? We argue that it does, in the case where A (...) is yourself. The capacity for "grit" involves a kind of epistemic resilience in the face of evidence suggesting that one might fail, and this makes it rational to respond to the relevant evidence differently when you are the agent in question. We then explore whether similar arguments extend to the case of "believing in" our significant others -- our friends, lovers, family members, colleagues, patients, and students. (shrink)