Conventionalists about promising believe that it is wrong to break a promise because the promisor takes advantage of a useful social convention only to fail to do his part in maintaining it. Anti-conventionalists claim that the wrong of breaking a promise has nothing essentially to do with a social convention. Anti-conventionalists are right that the social convention is not necessary to explain the wrong of breaking most promises. But conventionalists are right that the convention plays an essential role in any (...) satisfactory account of promising. A new conventionalism can explain this by appealing to special features of social conventions. Two of these special features have important implications for any moral requirements they mediate, such as the requirement to keep one's promises and the moral requirements attached to social or occupational roles. First, these requirements will not depend on features of a situation that are inaccessible to typical participants in the convention. Second, these requirements often cannot be tailored to fit the overly unusual circumstances of participants. (shrink)

In this paper, we provide a new framework for understanding infant-feeding-related maternal guilt and shame, placing these in the context of feminist theoretical and psychological accounts of the emotions of self-assessment. Whereas breastfeeding advocacy has been critiqued for its perceived role in inducing maternal guilt, we argue that the emotion women often feel surrounding infant feeding may be better conceptualized as shame in its tendency to involve a negative self-assessment—a failure to achieve an idealized notion of good motherhood. Further, we (...) suggest, both formula-feeding and breastfeeding mothers experience shame: the former report feeling that they fail to live up to ideals of womanhood and motherhood, and the latter transgress cultural expectations regarding feminine modesty. The problem, then, is the degree to which mothers are vulnerable to shame generally, regardless of infant feeding practices. As an emotion that is less adaptive and potentially more damaging than guilt, shame ought to be the focus of resistance for both feminists and breastfeeding advocates, who need to work in conjunction with women to oppose this shame by assisting them in constructing their own ideals of good motherhood that incorporate a sense of self-concern. (shrink)

“Wicked” problems are characterized by intractable complexity, uncertainty, and conflict between individuals or institutions, and they inhabit almost every corner of medical ethics. Despite wide acceptance of the same ethical principles, we nevertheless disagree about how to formulate such problems, how to solve them, what would _count_ as solving them, or even what the possible solutions _are_. That is, we don’t always know how best to implement ethical ideals in messy real-world contexts. I sketch an implementation framework for medical ethics (...) that can help clarify wicked problems and organize further ethics research toward their resolutions. This framework describes the procedural variables that work alongside substantive ethical ideals to deliver ethical decisions in complex real-world situations. Using controversial GM mosquito research as an example, I illustrate how the generalizable relationships between the variables clarify emerging ethical guidelines of research governance and provide a pathway to extend these guidelines in a way consistent with our ethical intuitions across a wide range of research and public health ethics. (shrink)

This paper argues that theoretical consistency and actionguidingness—as these have been formulated in the moral dilemmas debate—do not rule out interpersonal moral conflict. This leaves open the possibility that theoretical consistency and action-guidingness may demand more than what has been traditionally assumed. That question is considered here. Do these resources rule out all-things-considered interpersonal moral conflict in non-consequentialist theories? This paper argues that neither theoretical consistency nor action-guidingness can rule out such conflict, but action-guidingness properly construed provides a desideratum against (...) it. (shrink)

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents’ personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum’s goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as (...) they affect patient care. Content analysis of written reflections was guided by a tool developed to identify and assess the level of ethical reasoning in eight domains determined to be important aspects of ethical competence. Based on the assessment of narratives written at two times (12 to 16 months/apart) during their training, residents showed significant progress in two specific domains: use of professional values, and use of personal values. Residents did not show decline in ethical reasoning in any domain. This study demonstrates that content analysis of personal narratives may provide a useful method for assessment of developing ethical sensitivity and reasoning. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:To Shape a New World: Essays on the Political Philosophy of Martin Luther King, Jr. ed. by Tommie Shelby and Brandon M. TerryErin R. PinedaTommie Shelby and Brandon M. Terry, editors. To Shape a New World: Essays on the Political Philosophy of Martin Luther King, Jr. Cambridge, MA: Harvard University Press, 2020. Pp. 464. Paperback, $20.00.In the summer of 2020, as cities across the globe erupted in protest (...) after the murder of George Floyd, references to Martin Luther King, Jr. abounded: while a familiar cast of politicians evoked his memory to scold riotous protestors, others issued King's rejoinder that "the riot is the language of the unheard" (King, "The Other America," 1967). Many such invocations no doubt smacked of the "ritual celebration" and "intellectual marginalization" [End Page 339] that, as Tommie Shelby and Brandon M. Terry observe, have long marked King's reception as a political thinker (2). But in another sense, the seemingly inevitable return to King points to the significant stakes of taking his thought seriously and the political danger of laying claim to interpretive mastery. Struggles over King's legacy and the terms of his thought are not just about King but form part of the discursive terrain on which struggles over the demands of racial justice and the means of transformative collective action are waged.Shelby and Terry's ambitious, illuminating volume, To Shape a New World, first published in 2018 (timed to mark the fiftieth anniversary of King's assassination) and released as paperback in 2020 (amidst the George Floyd uprisings), invites us to take King seriously in just this sense: with an acute sensitivity to the stakes and an embrace of an interpretive pluralism that refuses the certainty of a singular, definitive reading. The collection facilitates rigorous engagement with King's thought in its own time and place but also presses the question of what we ought to do with it in this current "age of impunity and mendacity," standing amid the "unraveling" edges of "American empire," as Cornel West puts it (331). In posing and answering this question across its fifteen essays, the collection seeks to do justice to King as both a political philosopher and a political activist—a religious and political thinker whose philosophies were worked out not only behind the pulpit or within the academy, but also (and perhaps primarily) in concert with others on the field of political action. Indeed, one of its primary contributions is to challenge mainstream presumptions about what counts as political philosophy—its boundaries as a genre as well as the spaces where we imagine political philosophizing to happen and the figures we position as its primary producers.The volume is organized into four sections. The first, "Traditions," is devoted to exploring some of King's diverse intellectual influences. Here, the emphasis is less on making the case for particular traditions as the essential ones, and more on exploring the use of different interpretive lenses for shedding new light on his ideas. Three essays put King in context with thinkers he directly engaged: Robert Gooding-Williams places him in conversation with W. E. B. Du Bois and Booker T. Washington to reveal the structure of King's account of dignity amid the constraints of racial injustice; Bernard Boxill shows how King's theory of civil disobedience builds on—and collectivizes—Frederick Douglass's account of comparative freedom; and Karuna Mantena explores the theory of nonviolent action that King, through figures like Benjamin Mays and Howard Thurman, adopted and adapted from Gandhi. In contrast, Paul Taylor argues that we should read King in the company of moral perfectionists Stanley Cavell and Christopher Lebron—as showing us how practices of self-criticism, self-transformation, and experimentation enable "citizens to remain dissatisfied with things as they stand" while remaining "open to the possibility that justice will require reconstructing both society and the self" (41).In the next section, contributors turn their attention to King's "Ideals"—the ethical and political imperatives that shape the ends and means of the struggle for a new world. Like Mantena, Martha Nussbaum reads King alongside Gandhi to focus on King's insistence on channeling righteous... (shrink)

Charles Taylor has been one of the most original and influential figures in contemporary philosophy: his 'philosophical anthropology' spans an unusually wide range of theoretical interests and draws creatively on both Anglo-American and Continental traditions in philosophy. A selection of his published papers is presented here in two volumes, structured to indicate the direction and essential unity of the work. He starts from a polemical concern with behaviourism and other reductionist theories (particularly in psychology and the philosophy of language) (...) which aim to model the study of man on the natural sciences. This leads to a general critique of naturalism, its historical development and its importance for modern culture and consciousness; and that in turn points, forward to a positive account of human agency and the self, the constitutive role of language and value, and the scope of practical reason. The volumes jointly present some two decades of work on these fundamental themes, and convey strongly the tenacity, verve and versatility of the author in grappling with them. They will interest a very wide range of philosophers and students of the human sciences. (shrink)

The place of religion in society has changed profoundly in the last few centuries, particularly in the West. In what will be a defining book for our time, Taylor takes up the question of what these changes mean, and what, precisely, happens when a society becomes one in which faith is only one human possibility among others.

This classic, provocative introduction to classical metaphysical questions focuses on appreciating the problems, rather than attempting to proffer answers.

A beautifully written, deeply provocative inquiry into the intersection between animal and disability liberation--the debut of an important new social critic How much of what we understand of ourselves as "human" depends on our physical and mental abilities--how we move (or cannot move) in and interact with the world? And how much does our definition of "human" depend on its difference from "animal"? Drawing on her own experiences as a disabled person, a disability activist, and an animal advocate, author Sunaura (...) Taylor persuades us to think deeply, and sometimes uncomfortably, about what divides the human from the animal, the disabled from the nondisabled--and what it might mean to break down those divisions, to claim the animal and the vulnerable in ourselves, in a process she calls "cripping animal ethics." Beasts of Burden suggests that issues of disability and animal justice--which have heretofore primarily been presented in opposition--are in fact deeply entangled. Fusing philosophy, memoir, and science--including factory farming, disability oppression, or our assumptions of human superiority over animals--Taylor draws attention to new worlds of experience and empathy that will open up important avenues of solidarity across species and ability. Beasts of Burden is a wonderfully engaging and elegantly written work, both philosophical and personal, by a brilliant debut author. (shrink)

Erin Wunker is a feminist killjoy, and she thinks you should be one, too. Following in the tradition of Sara Ahmed (the originator of the concept "feminist killjoy"), Wunker brings memoir, theory, literary criticism, pop culture, and feminist thinking together in this collection of essays that take up Ahmed's project as a multi-faceted lens through which to read the world from a feminist point of view. Neither totemic nor complete, the non-fiction essays that make up Notes from a Feminist (...) Killjoy: Essays on Everyday Life attempt to think publicly about why we need feminism, and especially why we need the figure of the feminist killjoy, now. From the complicated practices of being a mother and a feminist, to building friendship amongst women as a community-building and -sustaining project, to writing that addresses rape culture from the Canadian context and beyond, Notes from a Feminist Killjoy: Essays on Everyday Life invites the reader into a conversation about gender, feminism, and living in our inequitable world. (shrink)

How does our conception of possibility contribute to our understanding of self and world? In what sense does the possible differ from the merely probable, and what would it mean to treat possibility as part of the real? This book is an opportunity to see Kierkegaard as contributing to a distinctive phenomenology, ontology, and psychology of possibility that addresses the question of our existential relationship to the possible. The term 'possibility' (Mulighed) and its variants occur with curious frequency across Kierkegaard's (...) writings. Key to Kierkegaard's understanding of the self, possibility is linked to a number of core concepts in his works: from imagination, anxiety, despair, and 'the moment' to the idea in The Sickness Unto Death that “God is that all things are possible”. Responding to what he sees as a Hegelian and Aristotelian misunderstanding of possibility, Kierkegaard offers a novel reading of the possible that, in turn, directly influences 20th-century philosophers such as Heidegger, Deleuze, and Derrida. Kierkegaard gives a rich account of how anxiety and despair, as lived experiences of possibility, not only show us the contingency and fragility of the systems and identities we presently inhabit but also reveal a more fundamental contingency that demands a new way of relating to the possible. For Kierkegaard, hope, faith, and love are attitudes in which meaning is forged by embracing contingency. In a time of political, social, and environmental uncertainty Kierkegaard's work on radical possibility seems more relevant than ever. (shrink)

A collection of essays examining the writings of William James. Provides a reinterpretation of pragmatism to devise philosophical resources for pragmatist feminism that challenge sexism and male privilege"--Provided by publisher.

Erin Plunkett draws from both analytic and continental sources to argue for the philosophical relevance of style, making the case that the essay form is uniquely suited to address the sceptical problem. The authors examined here-Montaigne, Hume, the early German Romantics, Kierkegaard and Stanley Cavell-bring into relief the relationship between scepticism and ordinary life and situate the will to know within a broader frame of meaningful human activity. The formal features of the essay call attention to time, subjectivity, and (...) language as the existential conditions of knowledge. -/- In contrast to foundationalist approaches, which expect philosophy to reach empirical or rational certainty, Plunkett demonstrates through these writings the philosophical advantages of a fragmentary, non-dogmatic style of writing. A Philosophy of the Essay shows how this medium can help us come to terms with the contingency and uncertainty of life. (shrink)

Introduction to Hegel's thought for the student and general reader, emphasizing in particular his social and political thought and his continuing relevance to contemporary problems.

Este ensayo busca trazar una genealogía defectuosa de varias escenas de lectura en la obra de Jacques Lezra. Se enfoca en la lectura como práctica metodológica salvaje que conjuga —de manera inesperada, contraintuitiva, e indisciplinada— objetos, discursos, y modalidades conceptuales. Se analiza una selección de escenas de lectura de Materialismo salvaje y República salvaje para identificar en ellas un pensamiento estético-político que imagina corrientes subterráneas y deconstruye conceptos como soberanía, institución, y normatividad, enfatizando su carácter defectuoso.

Sutland offers nine foundational mantras in her tri-fold approach to creating change, holistic wellness and fitness, and she will help you harness your body's mental, physical and spiritual energy in service to what you want.

Much has been made of the importance of training ethical, socially conscious engineers, but does US engineering education actually encourage neophytes to take seriously their professional responsibility to public welfare? Counter to such ideals of engagement, I argue that students’ interest in public welfare concerns may actually decline over the course of their engineering education. Using unique longitudinal survey data of students at four colleges, this article examines (a) how students’ public welfare beliefs change during their engineering education, (b) whether (...) engineering programs emphasize engagement, and (c) whether these program emphases are related to students’ public welfare beliefs. I track four specific public welfare considerations: the importance to students of professional/ethical responsibilities, understanding the consequences of technology, understanding how people use machines, and social consciousness. Suggesting a culture of disengagement, I find that the cultural emphases of students’ engineering programs are directly related to their public welfare commitments and students’ public welfare concerns decline significantly over the course of their engineering education. However, these findings also suggest that if engineering programs can dismantle the ideological pillars of disengagement in their local climates, they may foster more engaged engineers. (shrink)

The computations involved in statistical learning have long been debated. Here, we build on work suggesting that a basic memory process, chunking, may account for the processing of statistical regularities into larger units. Drawing on methods from the memory literature, we developed a novel paradigm to test statistical learning by leveraging a robust phenomenon observed in serial recall tasks: that short‐term memory is fundamentally shaped by long‐term distributional learning. In the statistically induced chunking recall (SICR) task, participants are exposed to (...) an artificial language, using a standard statistical learning exposure phase. Afterward, they recall strings of syllables that either follow the statistics of the artificial language or comprise the same syllables presented in a random order. We hypothesized that if individuals had chunked the artificial language into word‐like units, then the statistically structured items would be more accurately recalled relative to the random controls. Our results demonstrate that SICR effectively captures learning in both the auditory and visual modalities, with participants displaying significantly improved recall of the statistically structured items, and even recall specific trigram chunks from the input. SICR also exhibits greater test–retest reliability in the auditory modality and sensitivity to individual differences in both modalities than the standard two‐alternative forced‐choice task. These results thereby provide key empirical support to the chunking account of statistical learning and contribute a valuable new tool to the literature. (shrink)

Written by a diverse range of scholars, this accessible introductory volume asks: What is implicit bias? How does implicit bias compromise our knowledge of others and social reality? How does implicit bias affect us, as individuals and participants in larger social and political institutions, and what can we do to combat biases? An interdisciplinary enterprise, the volume brings together the philosophical perspective of the humanities with the perspective of the social sciences to develop rich lines of inquiry. Its 12 chapters (...) are written in a non-technical style, using relatable examples that help readers understand what implicit bias is, its significance, and the controversies surrounding it. Each chapter includes discussion questions and additional annotated reading suggestions. And a companion webpage contains teaching resources. The volume is invaluable resource for students―and researchers―seeking to understand criticisms surrounding implicit bias, as well as how one might answer them by adopting a more nuanced understanding of bias and its role in maintaining social injustice. (shrink)

If someone says, “Asians are good at math” or “women are empathetic,” I might interject, “you're stereotyping” in order to convey my disapproval of their utterance. But why is stereotyping wrong? Before we can answer this question, we must better understand what stereotypes are and what stereotyping is. In this essay, I develop what I call the descriptive view of stereotypes and stereotyping. This view is assumed in much of the psychological and philosophical literature on implicit bias and stereotyping, yet (...) it has not been sufficiently defended. The main objection to the descriptive view is that it fails to include the common-sense idea that stereotyping is always objectionable. I argue that this is actually a benefit of the view. In the essay's final part, I put forward two hypotheses that would validate the claim that stereotyping is always morally or epistemically wrong. If these hypotheses are false—which is very likely—we have little reason to build moral or epistemic defect into the very idea of a stereotype. Moreover, we must abandon the seemingly attractive claim that judging individuals based on group membership is intrinsically wrong. (shrink)

If someone says, “You’ve stereotyped me,” we hear the statement as an accusation. One way to interpret the accusation is as follows: you haven’t seen or treated me as an individual. In this essay, I interpret and evaluate a theory of wrongful stereotyping inspired by this thought, which I call the failure-to-individualize theory of wrongful stereotyping. According to this theory, stereotyping is wrong if and only if it involves failing to treat persons as individuals. I argue that the theory—however one (...) interprets it—is inadequate. Either the theory will not reliably identify all cases of wrongful stereotyping or it will fail to adequately explain why they are wrong. I conclude that it does not follow that we must entirely jettison the objection that stereotyping fails to treat persons as individuals. What follows is only that the objection must play a more circumscribed role in a theory of when and why stereotyping is wrong. (shrink)

In this study, I examine the effectiveness of a national board gender diversity disclosure requirement, which is, arguably, on the “soft” end of the continuum of boardroom interventions. Using a panel dataset of 1847 hand-collected corporate disclosures from 2015 to 2018, I perform a post-event, historical trend analysis of the efficacy of Canada's 2014 intervention. I find evidence of real progress in the 4 years following intervention against several benchmarks. Specifically, improvements in critical mass are documented, with the proportion of (...) boards with three of more women reaching 18.8% in 2018. Tokenism remains an issue with very little change in the number of Canadian boards with only one woman. Further analyses using a sorting methodology and panel regression analysis reveal that progress toward board gender diversity is achieved by those with board gender targets, board seat renewal policies, and written board diversity policies. In addition, I find that larger companies achieve greater progress and that progress is clustered by industry. (shrink)

In his Politics, Aristotle identifies the public worship of the gods as the most important element of the city, but then immediately follows this claim with the claim that justice is the most important element of the city. I first consider the various possible ways of interpreting this claim on the basis of Aristotle’s metaphysical commitments. I then consider what Aristotle actually says about religious worship. The things Aristotle says when elaborating public worship in the city indicate that the importance (...) of this public worship to the city is in establishing the leisure necessary for, and which turns the citizens toward, contemplation. This contemplation, the activity of science, is, as Aristotle elaborates in the Nicomachean Ethics, the most divine activity in which we can engage. Public religious worship, then, is essential to the activity of science in a city. (shrink)

Empirical science, such as psychology and neuroscience, employ diverse methods to develop data driven models and explanations for complex phenomena. In research on the self, differences in these methods produce different depictions of persons. Research in developmental psychology highlights the role of intuitive beliefs, such as psychological essentialism and intuitive dualism, in individuals’ singular, cohesive, and stable sense of self. On the other hand, research in neuroscience highlights the de-centralized, distributed, multitudes of neural networks in competition making selves, with arguments (...) around whether the interpretation of these data imply that the self is somehow fundamental and special to human functioning. In this paper, I explore these discrepant pictures of the self to advance understanding about personhood. Specifically, I suggest that these divergent pictures of self from psychology and neuroscience have the potential to inform philosophical and theological discussions around personhood by anchoring models of persons in empirical views of persons. Likewise, I explore the opportunity for philosophy and theology to inform and enhance scientific research on the self by critiquing scientific bias and construct development as well as highlighting potential limits in understanding selves with empirical models. (shrink)

Local food systems can have economic and social benefits by providing income for producers and improving community connections. Ongoing global climate change and the acute COVID-19 pandemic crisis have shown the importance of building equity and resilience in local food systems. We interviewed ten stakeholders from organizations and institutions in a U.S. midwestern city exploring views on past, current, and future conditions to address the following two objectives: 1) Assess how local food system equity and resilience were impacted by the (...) COVID-19 pandemic, and 2) Examine how policy and behavior changes could support greater equity and resilience within urban local food systems. We used the Community Capitals Framework to organize interviewees’ responses for qualitative analyses of equity and resilience. Four types of community capital were emphasized by stakeholders: cultural and social, natural, and political capital. Participants stated that the local food system in this city is small; more weaknesses in food access, land access, and governance were described than were strengths in both pre- and post-pandemic conditions. Stakeholder responses also reflected lack of equity and resilience in the local food system, which was most pronounced for cultural and social, natural and political capitals. However, local producers’ resilience during the pandemic, which we categorized as human capital, was a notable strength. An improved future food system could incorporate changes in infrastructure (e.g., food processing), markets (e.g., values-based markets) and cultural values (e.g., valuing local food through connections between local producers and consumers). These insights could inform policy and enhance community initiatives and behavior changes to build more equitable and resilient local food systems in urban areas throughout the U.S. Midwest. (shrink)

Cognitive Science, Volume 46, Issue 9, September 2022.

How linguistic structures evolve so as to become easier to process is addressed by Isbilen and Christiansen for the Now‐or‐Never bottleneck. The authors suggest that this fundamental challenge in language processing is coped with by rapid compression of the transient linguistic input into chunks then to be passed on. As linguistic structures that can be chunked more easily tend to stabilize and proliferate, language evolves to fit learners’ cognitive capabilities.

What role does traditional ecological knowledge play in the lives of smallholder farmers in post-conflict communities as they cope with the destructive impacts of war? In many cases, military weapons, such as unexploded bombs, are left behind in the surrounding landscape, forcing farmers to adapt their livelihood practices to the increased risk of death and injury. We analyze trends in the local production of knowledge in Ratanak Kiri province, Cambodia, an area heavily bombarded by the US Air Force during the (...) Vietnam War. We argue that the system of traditional ecological knowledge has adapted to include basic information on bomb identification, location, and management strategies. This factual approach gives individuals the flexibility to generate their own views on whether they perceive unexploded ordnance as a violent hazard and/or an economic commodity. In a relatively short 50-year time period, the body of knowledge has been quickly accumulated and culturally transmitted to family and neighbors. Our findings suggest that traditional ecological knowledge should not be reduced to a static and ancient form of collective memory. We call for the expansion of the concept of traditional ecological knowledge to include short-term and dynamic processes of knowledge generation. (shrink)

While people’s lives continue to be put at risk by the dearth of organs available for transplantation, we must give urgent consideration to any option that may make up the shortfall. A market in organs from living donors is one such option. The market should be ethically supportable, and have built into it, for example, safeguards against wrongful exploitation. This can be accomplished by establishing a single purchaser system within a confined marketplace.Statistics can be dehumanising. The following numbers, however, have (...) more impact than most: as of 24th November, during 2002 in the United Kingdom, 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.1 It is difficult to estimate how many people die prematurely for want of donor organs. “In the world as a whole there are an estimated 700 000 patients on dialysis . . . . In India alone 100 000 new patients present with kidney failure each year”2 . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . …. (shrink)