Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Our review identified four (...) major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

Neuroconstructivism, Vol. 1: How the Brain Constructs Cognition implies that brain functioning depends on biofeedback and ecological trajectories. Using the building blocks of Boolean algebra known as logic gates and models of distributed control systems, I suggest that levels of regulatory states are responsible for optimal, pathological, and developmental processes. I include the impact of regulatory and nonregulatory functions on structural development.

The diagnostic moment is a moment replete with drama. As Suzanne Fleischmann has written, hearing the announcement of a serious diagnosis draws an indelible line to demarcate before and after, which will be evermore imposed on an individual’s narrative construction of her life story. We can imagine this moment, considering with apprehension the “what if?” as we attend our doctor’s appointments for the verdict on what ails us. Belief in its transformative power is impressive. That we can imagine it is (...) not surprising, as it is represented so widely in various creative work. In this paper, I turn to the presence of the diagnostic moment in fiction. I love to read. This... (shrink)

Biofeedback mechanisms (a) between individuals, (b) between the individual and the society structures which shape individual cognitions, and (c) within the individual genetic biochemical circulation, may explain the diversity of trustworthiness potential and the option of mutual trust for every individual in any given society.

In recent years, a number of theorists have claimed that beliefs about probability are transparent. To believe probably p is simply to have a high credence that p. In this paper, I prove a variety of triviality results for theses like the above. I show that such claims are inconsistent with the thesis that probabilistic modal sentences have propositions or sets of worlds as their meaning. Then I consider the extent to which a dynamic semantics for probabilistic modals can capture (...) theses connecting belief, certainty, credence, and probability. I show that although a dynamic semantics for probabilistic modals does allow one to validate such theses, it can only do so at a cost. I prove that such theses can only be valid if probabilistic modals do not satisfy the axioms of the probability calculus. (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (shrink)

According to evolutionary, genetic, and endocrinal perspectives, gender differences are modulated by the interaction between intra-uterine stress, genetic equipments, and the availability of the facilitating environment during the newborn period. The social message of fitness over obstacles during socialization and the discussion of secure/non-secure attachment styles should take into consideration the brain functions, which are altered differently in response to intra- and extra-uterine stress in each gender.

Leon Goldstein’s critical philosophy of history has suffered a relative lack of attention, but it is the outcome of an unusual story. He reached conclusions about the autonomy of the discipline of history similar to those of R. G. Collingwood and Michael Oakeshott, but he did so from within the Anglo-American analytic style of philosophy that had little tradition of discussing such matters. Initially, Goldstein attempted to apply a positivistic epistemology derived from Hempel’s philosophy of natural science to (...) historical knowledge, but gradually formulated an anti-realistic epistemology that firmly distinguished historical knowledge of the past not only from the scientific perspective but also from fictional and common-sense attitudes to the past. Among his achievements were theories of the distinctive nature of historical evidence and historical propositions, of the constructed character of historical events, and of the relationship between historical research and contemporary culture. Taken together, his ideas merit inclusion among the most important twentieth-century contributions to the problem of historical knowledge. (shrink)

ABSTRACTLeon Goldstein's critical philosophy of history has suffered a relative lack of attention, but it is the outcome of an unusual story. He reached conclusions about the autonomy of the discipline of history similar to those of R. G. Collingwood and Michael Oakeshott, but he did so from within the Anglo‐American analytic style of philosophy that had little tradition of discussing such matters. Initially, Goldstein attempted to apply a positivistic epistemology derived from Hempel's philosophy of natural science to (...) historical knowledge, but gradually formulated an anti‐realistic epistemology that firmly distinguished historical knowledge of the past not only from the scientific perspective but also from fictional and common‐sense attitudes to the past. Among his achievements were theories of the distinctive nature of historical evidence and historical propositions, of the constructed character of historical events, and of the relationship between historical research and contemporary culture. Taken together, his ideas merit inclusion among the most important twentieth‐century contributions to the problem of historical knowledge. (shrink)

RESUMENEn este ensayo intento pagar una deuda pendiente que todos tenemos con Aron Gurwitsch y recuperar, para nuestra memoria, su importante contribución a la fenomenología durante los años que él estuvo exiliado en Francia (1933-1940). Fue él quien introdujo el pensamiento de Kurt Goldstein en Francia y fue él el primero en comprender (en los años veinte) que estaba naciendo un nuevo enfoque en las ciencias humanas y sociales y que hay una coincidencia entre ellas y la nueva filosofía (...) fenomenológica de Husserl: una tendencia a ir a las cosas tal como son vividas y manejadas por los sujetos. Este espíritu de confluencia entre la fenomenología y las otras ciencias es lo que le transmitió a Maurice Merleau-Ponty, su alumno y contertulio, pero sin que él reconociera nunca en sus escritos a Gurwitsch como una gran «fuente de inspiración» para su pensamiento. En este ensayo se presentan evidencias sobre la deuda impagada de Merleau-Ponty con respecto a Aron Gurwitsch.PALABRAS CLAVEGurwitsch – Merleau-Ponty – Goldstein – Fenomenología – Psicología de la GestaltABSTRACTIt is our aim in this essay to pay off a debt we owe to Aron Gurwitsch and to retrieve for our memory his important contribution to phenomenology during his years of exile in France (1933-1940). While there, he introduced the thought of Kurt Goldstein´s thought and was the first to understand that a new approach in the human and social sciences was emerging and converging with Husserl’s new phenomenological philosophy: a tendency towards things such as they are lived and handled by subjects. This spirit of confluence between phenomenology and the sciences is something he passed on to his younger colleague, Merleau-Ponty, who did not acknowledge Gurwitsch as a major «source of inspiration» for his thought. Some evidence of Merleau Ponty´s unpaid debt to Aron Gurwitsch is presented in this essay.KEY WORDSGurwitsch – Merleau-Ponty – Goldstein –Phenomenology – Gestalt´s Psychology. (shrink)

RESUMENEn este ensayo intento pagar una deuda pendiente que todos tenemos con Aron Gurwitsch y recuperar, para nuestra memoria, su importante contribución a la fenomenología durante los años que él estuvo exiliado en Francia (1933-1940). Fue él quien introdujo el pensamiento de Kurt Goldstein en Francia y fue él el primero en comprender (en los años veinte) que estaba naciendo un nuevo enfoque en las ciencias humanas y sociales y que hay una coincidencia entre ellas y la nueva filosofía (...) fenomenológica de Husserl: una tendencia a ir a las cosas tal como son vividas y manejadas por los sujetos. Este espíritu de confluencia entre la fenomenología y las otras ciencias es lo que le transmitió a Maurice Merleau-Ponty, su alumno y contertulio, pero sin que él reconociera nunca en sus escritos a Gurwitsch como una gran «fuente de inspiración» para su pensamiento. En este ensayo se presentan evidencias sobre la deuda impagada de Merleau-Ponty con respecto a Aron Gurwitsch.PALABRAS CLAVEGurwitsch – Merleau-Ponty – Goldstein – Fenomenología – Psicología de la GestaltABSTRACTIt is our aim in this essay to pay off a debt we owe to Aron Gurwitsch and to retrieve for our memory his important contribution to phenomenology during his years of exile in France (1933-1940). While there, he introduced the thought of Kurt Goldstein´s thought and was the first to understand that a new approach in the human and social sciences was emerging and converging with Husserl’s new phenomenological philosophy: a tendency towards things such as they are lived and handled by subjects. This spirit of confluence between phenomenology and the sciences is something he passed on to his younger colleague, Merleau-Ponty, who did not acknowledge Gurwitsch as a major «source of inspiration» for his thought. Some evidence of Merleau Ponty´s unpaid debt to Aron Gurwitsch is presented in this essay.KEY WORDSGurwitsch – Merleau-Ponty – Goldstein –Phenomenology – Gestalt´s Psychology. (shrink)

_Abstract_: In this paper, I will examine the Goldstein-Cassirer approach to neuropathology to determine its current potential for yielding valuable insights. To this end, I will reconstruct the philosophical and theoretical underpinnings of such a standpoint in the first four sections. What will emerge is that it entails a definition of pathology as the loss of balance in the adaption of human beings to the environment, leading to a lack of proclivity to categorical behaviour and symbolic performances. Furthermore, we (...) will see that there are behavioural alterations which are not related to the locus of lesions. In the fifth section, I will compare and contrast the holistic stances with current research in neuropsychology. The sixth section is dedicated to conclusive remarks. _Keywords_: Psychopathology; Neuropathology; Ernst Cassirer; Kurt Goldstein; Holism _ La mente ordinatrice. La concezione di Goldstein e Cassirer della neuropatologia e la sua rilevanza oggi _ _Riassunto_: In questo articolo intendo analizzare l’approccio Goldstein-Cassirer alla neuropatologia per comprendere se esso può rivelarsi ancora utile alla luce delle ricerche attuali. A tal fine, ne ricostruirò le basi filosofiche e teoriche nei primi tre paragrafi. Scopriremo che esso implica una definizione di patologia come perdita di equilibrio nell’adattamento degli esseri umani all’ambiente, a seguito della quale viene a mancare la naturale tendenza verso il “comportamento categoriale” e le prestazioni simboliche. Vedremo, inoltre, che vi sono alterazioni del comportamento non collegabili al sito delle lesioni. Nel quinto paragrafo, metterò a confronto le istanze olistiche con le ricerche contemporanee nel campo della neuropsicologia. Il sesto paragrafo contiene le considerazioni conclusive. _Parole chiave_: Psicopatologia; Neuropatologia; Ernst Cassirer; Kurt Goldstein; Olismo. (shrink)

Canguilhem is known to have regretted, with some pathos, that Life no longer serves as an orienting question in our scientific activity. He also frequently insisted on a kind of uniqueness of organisms and/or living bodies – their inherent normativity, their value-production and overall their inherent difference from mere machines. In addition, Canguilhem acknowledged a major debt to the German neurologist-theoretician Kurt Goldstein, author most famously of The Structure of the Organism in 1934; along with Merleau-Ponty, Canguilhem was the (...) main figure who introduced the work of Goldstein and his ‘phenomenology of embodiment’ into France. In this paper I inquire if we should view Canguilhem and Goldstein as ‘biochauvinists’, that is, as thinkers who consider that there is something inherently unique about biological entities as such, and if so, of what sort. (shrink)

Ao reatar o elo mais profundo entre a psicologia e a filosofia, Merleau-Ponty revisita a obra clínica de Kurt Goldstein (1878-1965), reavivando, em especial, seu contributo fenomenológico. As noções de "estrutura" (Gestalt) e "sentido" são, aqui, agenciadas quanto a uma compreensão mais integral do comportamento, da vida e da linguagem; alcance que Goldstein obtém, ao estudar os diferentes distúrbios linguísticos, na contramão das teorias intelectualistas e empiristas, essencialmente causais. Ao retomar esse inventário crítico, Merleau-Ponty atenta para o caráter (...) original, dinâmico e, sobretudo, ontológico dessa proposta. (shrink)

The author clarifies the existential philosophy that is implicit in Kurt Goldstein's philosophy of organism (Goldstein, 1963; 1995). Situated in response to the growing trend that psychological phenomena are reducible to the nervous system, the author argues for the reverse: that the significance of nervous system activity can only be understood by viewing it as background to foreground performances. Like the organization of perception into meaningful figure-- ground Gestalts, the existential modes of embodiment, sociality, temporality, spatiality, and attunement (...) are organized together to accomplish foreground performances. It is only within this context that the activity of the nervous system may be understood as significant or insignificant. Speech is given as an example. The article concludes with a commentary on how the trend of reducing psychological phenomena to neurological phenomena has impaired our understanding of brain disorders and psychological disorders. (shrink)

This article examines the mutual influence between Ernst Cassirer and his cousin, the neurologist Kurt Goldstein. For both Cassirer and Goldstein, views on the nature of human cognition were fundamental to their understanding of scientific knowledge, and these were informed by both philosophical theorizing and empirical research on pathologies of the nervous system. Following Cassirer, and in agreement with the physicalism of the Vienna Circle, Goldstein held that the physical sciences had progressed by arriving at abstract, mathematical (...) representations to take the place of qualitative characterizations of observable reality. In tension with physicalism, Goldstein was not sanguine about the fruitfulness of the abstractive approach in biology. He proposed that biology must adhere to its own sui generis methods of observation and experimentation in order to obtain knowledge of the “natures” of living organisms. I argue that there is a parallel with Cassirer’s assertion of the differences between physical and cultural sciences, underwritten by the deployment of varying symbolic functions. I also propose that the neurological writings of Goldstein are an important backdrop to Cassirer’s positive evaluation of abstract thought, in contrast to the pessimism regarding a worldview dominated by scientific abstractions expressed by philosophers such as Bergson, Whitehead, and Husserl. (shrink)

Although Niels Bohr's notion of complementarity is usually referred to in the context of quantum mechanics, it is not of physical origin. Bohr derived it from the philosophical idea of a holistic entanglement of knowledge and action. Bohr's complementarity primarily refers to a key element of the pragmatist tradition, the reflective relation between the immediate experience of an object and the awareness of its objectification. Similar relations have been observed by Kurt Goldstein in his studies of brain-injured patients. From (...) a pragmatic point of view, Goldstein's idea of adequacy in biological knowledge might lead to novel approaches to current ethical questions in medicine as well as biotechnology. (shrink)

The present study proposes an investigation into the reasons why Merleau-Ponty recognizes, in Goldstein’s incorporation of the figure-ground notion from the Gestalt Psychology, the convergence between contemporary science and phenomenological philosophy. It is about understanding how, insofar as it reveals the power of centering that operates in the concreteness of the existence of organisms in the surroundings, the notion of figure-background corresponds to the phenomenological notion of operative intentionality. In the same way, it is a matter of showing in (...) what sense, as a form of operative intentionality, the power of centering of organisms does not need to be based on the presupposition of an “I think”. Keywords: Merleau-Ponty; Goldstein; Gestalt; organismic intentionality. (shrink)

In ‘The Sorites is disguised nonsense’ Analysis (2012) 77: 61–5 L Goldstein attempts to show that some of the conditionals in any Sorites argument are nonsensical, and hence no Sorites argument can be sound. I give four reasons why this is not the case.

Dans sa thèse de médecine de 1943 sur le normal et le pathologique, Georges Canguilhem se sert largement des idées de Kurt Goldstein lorsqu’il définit la normalité comme la capacité de l’organisme à créer de nouvelles normes de vie dans un débat polarisé avec son milieu. Pourtant, il déclara ensuite que les conceptions de Goldstein avaient constitué pour lui un « encouragement et non une inspiration ». Les archives personnelles de Canguilhem nous permettent effectivement de considérer le rapport (...) de Canguilhem à Goldstein comme une convergence plutôt que comme une influence mais surtout, l’usage que Canguilhem fait de Goldstein nous permet de mieux saisir la portée de ses propres idées. Nous interrogeons dans une première partie la conception holiste de l’organisme de Goldstein, dans ses rapports à la gestalt-théorie et à Kant, conception qui se réfère au processus d’actualisation de l’essence de l’organisme dans son rapport avec le milieu. Ceci nous permet d’appréhender l’usage que fait Canguilhem de certains concepts et idées de Goldstein pour élaborer son propre concept de normativité vitale. Dans une deuxième partie, nous nous proposons de comprendre la manière dont Canguilhem pose le problème du rapport de la connaissance à la normativité vitale à partir de sa lecture des textes du neurologue allemand. (shrink)