Used appropriately, reliance on science distinguishes public health from policymaking driven more by theory and opinion and enhances trust in public health interventions. Evidence-based vaccine policymaking aims to control communicable disease by urging decision makers to base policies on the best available evidence rather than politics or personal views. The results of this approach, such as smallpox eradication, have been dramatic. Historically, mandatory childhood vaccination has been perhaps the most successful evidence-based tool in combating many epidemics. Philosophically, vaccination mandates correspond (...) to the legal system’s dual role in codifying what society deems undesirable behavior and declaring beneficial social norms and values consistent with understandings of the social contract. Despite their effectiveness and philosophical grounding, vaccination mandates present serious legal and ethical questions. Public health policymakers have a continuing responsibility to rely on evidence not only as a basis for generating policy, but also for evaluating and improving elements of its legal design. (shrink)

Obesity is a particularly vexing public health challenge, since it not only underlies much disease and health spending but also largely stems from repeated personal behavioral choices. The newly enacted comprehensive health reform law contains a number of provisions to address obesity. For example, insurance companies are required to provide coverage for preventive-health services, which include obesity screening and nutritional counseling. In addition, employers will soon be able to offer premium discounts to workers who participate in wellness programs that emphasize (...) behavioral choices. These policies presume that government intervention to reduce obesity is necessary and justified. Some people, however, argue that individuals have a compelling interest to pursue their own health and happiness as they see fit, and therefore any government intervention in these areas is an unwarranted intrusion into privacy and one's freedom to eat, drink, and exercise as much or as little as one wants. This paper clarifies the overlapping individual, employer, and social interest in each person's health generally to avoid obesity and its myriad costs in particular. The paper also explores recent evidence on the impact of government interventions on obesity through case studies on food labeling and employer-based anti-obesity interventions. Our analysis suggests a positive role for government intervention to reduce and prevent obesity. At the same time, we discuss criteria that can be used to draw lines between government, employer, and individual responsibility for health, and to derive principles that should guide and limit government interventions on obesity as health reform's various elements (e.g., exchanges, insurance market reforms) are implemented in the coming years. (shrink)

Lachlan observed that any nonzero d.c.e. degree bounds a nonzero c.e. degree. In this paper, we study the c.e. predecessors of d.c.e. degrees, and prove that given a nonzero d.c.e. degree , there is a c.e. degree below and a high d.c.e. degree such that bounds all the c.e. degrees below . This result gives a unified approach to some seemingly unrelated results. In particular, it has the following two known theorems as corollaries: there is a low c.e. degree isolating (...) a high d.c.e. degree [S. Ishmukhametov, G. Wu, Isolation and the high/low hierarchy, Arch. Math. Logic 41 259–266]; there is a high d.c.e. degree bounding no minimal pairs [C.T. Chong, A. Li, Y. Yang, The existence of high nonbounding degrees in the difference hierarchy, Ann. Pure Appl. Logic 138 31–51]. (shrink)

The analysis of a previous paper (see Ref. 1), in which the possibility of a Finslerian generalization of the equations of motion of gravitational field sources was demonstrated, is extended by developing the Finslerian generalization of the gravitational field equations on the basis of the complete contractionK = K lj lj of the Finslerian curvature tensorK l j hk (x, y). The relevant Lagrangian is constructed by the replacement of the directional variabley i inK by a vector fieldy i (x), (...) so that the notion of osculation may be regarded as the key concept on which the approach is based. The introduction of the auxiliary vector fieldy i (x) is shown to be of physical significance, for the field equations refer not only to the proper field variables but also to a special coordinate system associated withy i (x) through the Clebsch representation of the latter. The status of the conservation laws proves to be similar to that in the theory of the Yang-Mills field. By choosing a special Finslerian metric function we elucidate in detail the structure of the field equations in the static case. (shrink)

Previous research suggests that social anxiety symptoms are maintained and intensified by inflexible emotion regulation (ER). Therefore, we examined whether trait-level social anxiety moderates ER flexibility operationalised at both between-person (covariation between variability in emotional intensity and variability in strategy use across occasions) and within-person (associations between emotional intensity and strategy use on a given day) levels. In a sample of healthy college-aged adults (N = 185, Mage = 21.89), we examined overall and emotion-specific intensities (shame, guilt, anxiety, anger, sadness) (...) and regulatory strategies (i.e. experiential avoidance, expressive suppression, and rumination) in response to each day’s most emotionally intense event over 6 days. During the study period, we found a positive association between variability in emotional intensity and variability of experiential avoidance in individuals with lower, rather than higher, levels of trait social anxiety after controlling for key covariates (i.e. gender, personality traits, and stress exposure). However, we did not find evidence for the moderating role of trait social anxiety in ER flexibility assessed at within-person levels. Our findings highlight the need to delineate dynamic ER flexibility across everyday events. (shrink)

Purpose of the study is to find out the interdependence of the event as a factor of transformations in the established areas of human life and everyday routine as a way of existence of social being, which cover various types of human activity. Theoretical basis of the research is based on understanding of everyday routine as a form of social reality, a complex and multidimensional object that is constantly evolving, includes new forms of reality, and is influenced by various social (...) changes. The main function of everyday routine is the survival of individual and society, therefore the stable foundations of human existence play a dominant role in every life. In turn the event serves as a way of being existence, has a singular character, an individual expression, identifies elements that do not fit into the usual framework of everyday life. Originality of the obtained results lies in understanding event as the opposition of the phenomena world to the out of experience world of being, unexpected innovation that leads to the emergence of behaviours and structures that are new and unusual for everyday life. Event is not identical to empirical facticity, does not correspond to the usual understanding of phenomena and processes, and leads to a break from the everyday life, as it causes significant changes in human life on the individual and social levels. Unexpected change in everyday life caused by event is a traumatic collision with another dimension of being for an individual, as a result of it new meanings may open. Conclusions. On the background of everyday life, which is able to be in different states, function in a variety of relationships, to be manifested in numerous structures, junctions and connections, the event assumes the prospect of a new reality, contrary to previous representations. From existential point of view, event is always an interruption of everyday life, as for example, love or religious conversion. A large-scale event causes shocks that affect most or all individuals and communities that use multiple ways to react to an event – interpretation, selection, glorification, silence, valuations adjustment, phenomena, facts, celebration of holidays, rituals that are periodically repeated. (shrink)

Much progress has been made in the Soviet Union and a number of other socialist countries in studying and advancing the heritage of Marx and Engels in esthetics. The enrichment of our notions of the views of the founders of Marxism with respect to esthetics and literary criticism has promoted the further development of the discipline of esthetics. The progress achieved is the result and continuation of the work done by the older generation of Soviet philosophers, critics, and students of (...) literature fully thirty and thirty-five years ago in studying and elaborating the heritage of Marx and Engels. (shrink)

This is a brief, clear, and vigorous reinterpretation of Bergson's philosophy. The author attempts to prove that, far from being an irrationalist, Bergson is a systematic metaphysician firmly committed to the concept of final cause.

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

This study investigated the differences between past and future temporal discounting in terms of neural activity in relation to temporal distance. Results show that brain regions are engaged differently in past and future temporal discounting. This is likely because past temporal discounting requires memory reconstruction, whereas future temporal discounting requires the processing of uncertainty about the future. In past temporal discounting, neural activity differed only when preferences were made between rewards received one hour prior and rewards received further in the (...) past. The peak amplitudes of P2 and P3 varied as the temporal distance increased from 2 weeks to 50 years. In future temporal discounting, neural activity differed only when preferences were evaluated between two delayed rewards. The delay conditions and had a significant influence on P2 and N2. Findings indicate the existence of different decision-making systems operating in past and future temporal discounting. (shrink)

Presenting evidence from the social brain, we argue that neural reuse is a dynamic, socially organized process that is influenced ontogenetically and evolutionarily by the cultural transmission of mental techniques, values, and modes of thought. Anderson's theory should be broadened to accommodate cultural effects on the functioning of architecturally similar neural systems, and the implications of these differences for reuse.

In his 1936 paper,On the Concept of Logical Consequence, Tarski introduced the celebrated definition oflogical consequence: “The sentenceσfollows logicallyfrom the sentences of the class Γ if and only if every model of the class Γ is also a model of the sentenceσ.” [55, p. 417] This definition, Tarski said, is based on two very basic intuitions, “essential for the proper concept of consequence” [55, p. 415] and reflecting common linguistic usage: “Consider any class Γ of sentences and a sentence which (...) follows from the sentences of this class. From an intuitive standpoint it can never happen that both the class Γ consists only of true sentences and the sentenceσis false. Moreover, … we are concerned here with the concept of logical, i.e.,formal, consequence.” [55, p. 414] Tarski believed his definition of logical consequence captured the intuitive notion: “It seems to me that everyone who understands the content of the above definition must admit that it agrees quite well with common usage. … In particular, it can be proved, on the basis of this definition, that every consequence of true sentences must be true.” [55, p. 417] The formality of Tarskian consequences can also be proven. Tarski's definition of logical consequence had a key role in the development of the model-theoretic semantics of modern logic and has stayed at its center ever since. (shrink)

We construct a nonlow2 r.e. degree d such that every positive extension of embeddings property that holds below every low2 degree holds below d. Indeed, we can also guarantee the converse so that there is a low r.e. degree c such that that the extension of embeddings properties true below c are exactly the ones true belowd.Moreover, we can also guarantee that no b ≤ d is the base of a nonsplitting pair.

BackgroundBreast cancer patients are at elevated risk of depression during treatment, thus provoking the chance of poor clinical outcomes. This retrospective cohort study aimed to investigate whether integrating Chinese herbal medicines citation into conventional cancer therapy could decrease the risk of depression in the long-term breast cancer survivors.MethodsA cohort of patients aged 20–70 years and with newly diagnosed breast cancer during 2000–2008 was identified from a nationwide claims database. In this study, we focused solely on survivors of breast cancer at (...) least1 year after diagnosis. After one-to-one matching for age, sex, and baseline comorbidities, breast cancer patients who received and did not receive CHM treatment were enrolled. The incidence rate and hazard ratio citation for depression between the two groups was estimated at the end of 2012. A Cox proportional hazard model was constructed to examine the impact of the CHM use on the risk of depression.ResultsDuring the study period, the incidence rate of depression was significantly lower in the treated cohort than in the untreated cohort [8.57 compared with 11.01 per 1,000 person-years citation], and the adjusted HR remained significant at 0.74 in a Cox proportional hazards regression model. The corresponding risk further decreasing to 43% among those using CHM for more than 1 year.ConclusionFinding from this investigation indicated that the lower risk of depression observed in breast cancer patients treated with CHM, suggesting that CHM treatment should be considered for disease management toward breast cancer. Yet, the optimal administered dose should be determined in further clinical trials. (shrink)

Nurse practitioners can ease increased pressure on primary care shortage while providing a cost-effective and high-quality alternative to certain physician services. However, scope-of-practice laws are restrictive and their modification remains a source of controversy. Clearly, there is a need for new thinking around the scope of practice debate. This article conducted a review of literature and laws concerning the nursing scope of practice, as well as the outcomes of nurse-led care coordination models. It also examined different manifestations of the controversy (...) that arises in scope of practice debates. We argue that improved care coordination is necessary to improve outcomes and “bend the cost curve downward.” Allowing nurse practitioners and other providers to practice to the full extent of their licenses will result in improved care coordination. This can be accomplished by expanding nursing and other providers' scopes of practice. But any health care reform strategy, particularly with respect to chronic care management, must also serve to activate the patient herself as the keystone in the coordinated care process. Focusing first on the patient's need for coordinated care may be what is necessary to move beyond the existing impasse between physicians and nurses on scope of practice expansion. (shrink)

Recent developments in the health care industry have precipitated a new wave of interest in expanding the scope of practice for nursing. This is because the Patient Protection and Affordable Care Act, broadly designed to increase access to health insurance, will inevitably result in increased demand for primary care providers. And with compensation for primary care physicians already lagging far behind that of specialists, the role of nurse practitioners is once again receiving increased attention as a viable means by which (...) to ease the pressure for access to health care.But the economics of this trade-off are controversial. On one hand, it sets primary care physicians at odds with specialists; namely, if the ultimate goal is to “bend the cost curve downward,” should specialist compensation be reduced in order to increase spending on primary care? (shrink)

As the baby boomer generation ages, the need for laws to enhance quality of life for the elderly and meet the increasing demand for family caregivers will continue to grow. This paper reviews the national family leave laws of nine major OECD countries (Canada, Denmark, France, Germany, Italy, Japan, Netherlands, Spain, and the United Kingdom) and provides a state-by-state analysis within the U.S. We find that the U.S. has the least generous family leave laws among the nine OECD countries. With (...) the exception of two states (California and New Jersey), the U.S. federal Family Medical Leave Act of 1993 provides no right to paid family leave for eldercare. We survey the current evidence from the literature on how paid leave can impact family caregivers' employment and health outcomes, gender equality, and economic arguments for and against such laws. We argue that a generous and flexible family leave law, financed through social insurance, would not only be equitable, but also financially sustainable. (shrink)