Strategies to increase influenza vaccination rates have typically targeted healthcare professionals and individuals in various high-risk groups such as the elderly. We argue that they should focus on increasing vaccination rates in children. Because children suffer higher influenza incidence rates than any other demographic group, and are major drivers of seasonal influenza epidemics, we argue that influenza vaccination strategies that serve to increase uptake rates in children are likely to be more effective in reducing influenza-related morbidity and mortality than those (...) targeting HCPs or the elderly. This is true even though influenza-related morbidity and mortality amongst children are low, except in the very young. Further, we argue that there are no decisive reasons to suppose that children-focused strategies are less ethically acceptable than elderly or HCP-focused strategies. (shrink)

Virtue epistemology is among the dominant influences in mainstream epistemology today. An important commitment of one strand of virtue epistemology – responsibilist virtue epistemology (e.g., Montmarquet 1993; Zagzebski 1996; Battaly 2006; Baehr 2011) – is that it must provide regulative normative guidance for good thinking. Recently, a number of virtue epistemologists (most notably Baehr, 2013) have held that virtue epistemology not only can provide regulative normative guidance, but moreover that we should reconceive the primary epistemic aim of all education as (...) the inculcation of the intellectual virtues. Baehr’s picture contrasts with another well-known position – that the primary aim of education is the promotion of critical thinking (Scheffler 1989; Siegel 1988; 1997; 2017). In this paper – that we hold makes a contribution to both philosophy of education and epistemology and, a fortiori, epistemology of education – we challenge this picture. We outline three criteria that any putative aim of education must meet and hold that it is the aim of critical thinking, rather than the aim of instilling intellectual virtue, that best meets these criteria. On this basis, we propose a new challenge for intellectual virtue epistemology, next to the well-known empirically-driven ‘situationist challenge’. What we call the ‘pedagogical challenge’ maintains that the intellectual virtues approach does not have available a suitably effective pedagogy to qualify the acquisition of intellectual virtue as the primary aim of education. This is because the pedagogic model of the intellectual virtues approach (borrowed largely from exemplarist thinking) is not properly action-guiding. Instead, we hold that, without much further development in virtue-based theory, logic and critical thinking must still play the primary role in the epistemology of education. (shrink)

Virtue epistemology is among the dominant influences in mainstream epistemology today. An important commitment of one strand of virtue epistemology – responsibilist virtue epistemology – is that it must provide regulative normative guidance for good thinking. Recently, a number of virtue epistemologists have held that virtue epistemology not only can provide regulative normative guidance, but moreover that we should reconceive the primary epistemic aim of all education as the inculcation of the intellectual virtues. Baehr’s picture contrasts with another well-known position (...) – that the primary aim of education is the promotion of critical thinking. In this paper – that we hold makes a contribution to both philosophy of education and epistemology and, a fortiori, epistemology of education – we challenge this picture. We outline three criteria that any putative aim of education must meet and hold that it is the aim of critical thinking, rather than the aim of instilling intellectual virtue, that best meets these criteria. On this basis, we propose a new challenge for intellectual virtue epistemology, next to the well-known empirically-driven ‘situationist challenge’. What we call the ‘pedagogical challenge’ maintains that the intellectual virtues approach does not have available a suitably effective pedagogy to qualify the acquisition of intellectual virtue as the primary aim of education. This is because the pedagogic model of the intellectual virtues approach is not properly action-guiding. Instead, we hold that, without much further development in virtue-based theory, logic and critical thinking must still play the primary role in the epistemology of education. (shrink)

Purposeful infection of healthy volunteers with a microbial pathogen seems at odds with acceptable ethical standards, but is an important contemporary research avenue used to study infectious diseases and their treatments. Generally termed ‘controlled human infection studies’, this research is particularly useful for fast tracking the development of candidate vaccines and may provide unique insight into disease pathogenesis otherwise unavailable. However, scarce bioethical literature is currently available to assist researchers and research ethics committees in negotiating the distinct issues raised by (...) research involving purposefully infecting healthy volunteers. In this article, we present two separate challenge studies and highlight the ethical issues of human challenge studies as seen through a well-constructed framework. Beyond the same stringent ethical standards seen in other areas of medical research, we conclude that human challenge studies should also include: independent expert reviews, including systematic reviews; a publicly available rationale for the research; implementation of measures to protect the public from spread of infection beyond the research setting; and a new system for compensation for harm. We hope these additions may encourage safer and more ethical research practice and help to safeguard public confidence in this vital research alternative in years to come. (shrink)

This study contributes to understanding stakeholder engagement strategies by examining competitive responses alongside sociopolitical implications after a major exogenous shock—the 1998 Master Settlement Agreement (MSA) between the “Big Four” U.S. tobacco firms and 46 state attorneys general. We compare the different stakeholder engagement strategies of the two remaining U.S. tobacco manufacturers, Philip Morris (PM) and R. J. Reynolds (RJR), between 1998 and 2017. Implications for stakeholder theory from a relatively rare natural experiment highlight the importance of simultaneously managing multiple stakeholders, (...) inclusive of domestic and international sociopolitical and value chain stakeholders over time, for sustained value creation. Although PM and RJR initially pursued heterogeneous strategies by re-configuring relationships with relevant stakeholders, each firm’s growth prospects for the first decade post-MSA were exacerbated by various stakeholders through withholding and selective engagement strategies. Implications for how multiple, simultaneous stakeholder relationships can serve as important resources for achieving or limiting sustained growth are discussed. (shrink)

The problem of stability in population dynamics concerns many domains of application in demography, biology, mechanics and mathematics. The problem is highly generic and independent of the population considered (human, animals, molecules,…). We give in this paper some examples of population dynamics concerning nucleic acids interacting through direct nucleic binding with small or cyclic RNAs acting on mRNAs or tRNAs as translation factors or through protein complexes expressed by genes and linked to DNA as transcription factors. The networks made of (...) these interactions between nucleic acids (considered respectively as edges and nodes of their interaction graph) are complex, but exhibit simple emergent asymptotic behaviours, when time tends to infinity, called attractors. We show that the quantity called attractor entropy plays a crucial role in the study of the stability and robustness of such genetic networks. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

This paper challenges a pervasive, if not always explicit assumption of the present state of theorising in business ethics. This is the idea that a workable theory of organizational ethics must provide a unified perspective on its subject matter. In this paper we will sketch the broad outlines of an alternative understanding of business ethics, which focuses on constraints on corporate conduct that cannot reasonably be rejected. These constraints stem from at least three different levels or spheres of social reality, (...) i.e. the preconditions of a well-ordered society, the internal morality of economic activity and the preconditions of autonomous agency. (shrink)

Decision making theory in general, and mental models in particular, associate judgment and choice. Decision choice follows probability estimates and errors in choice derive mainly from errors in judgment. In the studies reported here we use the Monty Hall dilemma to illustrate that judgment and choice do not always go together, and that such a dissociation can lead to better decision-making. Specifically, we demonstrate that in certain decision problems, exceeding working memory limitations can actually improve decision choice. We show across (...) four experiments that increasing the number of choice alternatives forces people to collapse choices together, resulting in better decision-making. While choice performance improves, probability judgments do not change, thus demonstrating an important dissociation between choice and probability judgments. We propose the Collapsing Choice Theory (CCT) which explains how working memory capacity, probability estimation, choice alternatives, judgment, and regret all interact and effect decision quality. (shrink)

In the study of expertise, few debates come as big as that between constructivists and realists. This chapter discusses the signal debate between realists and constructivists about expertise. It sets out a view that includes aspects of both the constructivist and realist position to show that insights from what is often considered to be rival camps can be incorporated in a position that does justice to both. The chapter argues that, while expertise is real, there are two distinct social dimensions (...) to the concept of expertise. It attempts to demonstrate two distinct ways in which expertise has a social dimension. First, the chapter develops an account according to which 'is an expert' is a triadic predicate. Second, it considers the fact that attributions of expertise are often done by institutions, i.e. by medical boards certifying doctors, etc. Both dimensions can be acknowledged without undermining the basic case for realism about expertise. (shrink)

Kotzee and Smit explain why, if unicorns don't exist, then they could not possibly have existed. In fact, even if horned horses were discovered somewhere, they would not necessarily be unicorns. The key to understanding why this is so lies in understanding how so-called natural kind terms function.

Fragile X syndrome is the most common cause of inherited mental retardation in humans. The fragile X gene (FMR1) has been cloned and the mutation causing the disease is known. The molecular basis of the disease is an expansion of a trinucleotide repeat sequence (CGG) present in the first exon within the 5′ untranslated region of the FMR1 gene. Affected individuals have repeat CGG sequences of above 200. As a result the gene is not producing protein. It has been shown (...) that the FMR1 protein has RNA binding activity, but the function of this RNA binding activity is not known. The timing and mechanism of repeat amplification are not yet understood. An animal model for fragile X syndrome has been generated, which can be used to study the clinical and biochemical abnormalities caused by absence of FMR1 protein product. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative SymposiumPersonal Narratives Experiences of Psychiatric HospitalizationV. Barnard, J. Carson, Eugene Doe, Robin Driben, Anonymous One, Anonymous Two, Charles Kelley, Michael Kerins, D. Millman, Anonymous Three, Viesia Novosielski, Ben Zion, and Anonymous Four• Dreaming: A Recovery Story• The Intervention of the Demon• Bent but Not Broken• Tortured Souls Do Not Rest• Homesick• A Professional Patient No More• My Spiritual Journey• Personal Account of Psychiatric Hospitalization• Psychiatric Hospitalization Story• As (...) Ice Is to Water• The Power Of Human-To-Human Contact• Dignity• HospitalizationCopyright © 2011 The Johns Hopkins University Press... (shrink)

It is suggested that a clear prophetic voice of the congregational gathering could change the society to which the congregants belong. The problem is that this prophetic voice seems to have disappeared in many cases. A solution might be found if the point of view is taken that the prophetic voice in the congregational gathering is heard in the liturgical acts or rites. In the science of Liturgy attention must be given to the revitalisation of the gift of prophesy. In (...) this article the prophetic testimony of the Old Testament prophets and of the Prophet, Jesus Christ, were used as sources. Following in the footsteps of Brueggemann, an effort will be made to establish in relevant scripture passages what the attitude and practise of prophetic testimony should be. The possibility of rendering service through prophetic testimony as a liturgical act in the South African society is wide open. Prophetic testimony serves to criticise the dominant perception in order to dismantle it, but is also serves to energise persons and communities by its promise of another time and situation towards which the community of faith could move. (shrink)

In 1977 a seminal paper was published by Avinash Dixit and Joseph Stiglitz that revolutionized the modeling of imperfectly competitive markets. It launched what might be called the second monopolistic competition revolution, which has been far more successful than the first one, initiated by Edward Chamberlin and Joan Robinson in the 1930s. In this 2003 collection of essays experts in the fields of macroeconomics, international trade theory, economic geography, and international growth theory address the question of why the second revolution (...) was so successful. They also highlight what is missing, and look forward to the next step in the modeling of imperfectly competitive markets. The text includes a comprehensive survey of both monopolistic competition revolutions, and previously unpublished working papers by Dixit and Stiglitz that led to their famous 1977 paper. With contributions from Dixit, Ethier, Neary and Stiglitz amongst others, this collection will excite interest amongst researchers, advanced students and economists. (shrink)

fusion theory challenges efforts to see theory as inhibiting by presenting an approach that is innovative, eclectic, and subtle in order to draw out competing and constellating ideas and opinions. This collected volume of essays examines fusion theory and demonstrates how the theory can be applied to the reading of various works of Indian English novelists.

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

"Our scientific theory can indeed go wrong," writes Quine, "and precisely in the familiar way: through failure of predicted observation. But what if, happily and unbeknownst, we have achieved a theory that is conformable to every possible observation, past and future? In what sense could the world then be said to deviate from what the theory claims? Clearly in none....".

Although William Lyons's study of Ryle is designed "primarily" as a "simple, clear and basically sympathetic introduction to his work... in a way that is digestible by a tyro in philosophy," more advanced students of the subject will find it useful largely for its extended effort to absorb and assess the body of criticism that has accumulated around The Concept of Mind, not least of all Ryle's own during the last twenty-five years of his life when he produced a long (...) series of supplementary articles calculated to remedy "the perfunctoriness" with which, in his own words, he had dealt with "Mind qua pensive.". (shrink)

This paper challenges a pervasive, if not always explicit assumption of the present state of theorising in business ethics. This is the idea that a workable theory of organizational ethics must provide a unified perspective on its subject matter. In this paper we will sketch the broad outlines of an alternative understanding of business ethics, which focuses on constraints on corporate conduct that cannot reasonably be rejected. These constraints stem from at least three different levels or spheres of social reality, (...) i.e. the preconditions of a well-ordered society, the internal morality of economic activity and the preconditions of autonomous agency. (shrink)

In many areas of the social and behavioral sciences, the nature of the experiments and theories that best capture the underlying constructs are themselves areas of active inquiry. Integrative experiment design risks being prematurely exploitative, hindering exploration of experimental paradigms and of diverse theoretical accounts for target phenomena.