Objective: To determine whether the marks in the third year Objective Structured Clinical Examination were affected by the collusion reported by the students themselves on an electronic discussion board.Design: A review of the student discussion, examiners’ feedback and a comparison of the marks obtained on the 2 days of the OSCE.Participants: 255 third year medical students.Setting: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school.Results: 40 students contributed to the discussion on (...) the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference was observed in the overall mark for the OSCE on day 1 ) and day 2 ). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station where 82 students on day 2 incorrectly gave the diagnosis from day 1.Conclusion: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (shrink)

P.M.S. Hacker 1. _The problems of Intentionality_ The problems of intentionality have exercised philosophers since the dawn of their subject. In the last century they were brought afresh into the limelight by Brentano. Famously he remarked that.

P. M. S. Hacker 1. The ‘confusion of psychology’ On the concluding page of what is now called ‘Part II’ of the Investigations, Wittgenstein wrote.

1. The Tractatus doctrine of saying and showing In a letter to Russell dated 19.4.1919, written shortly after he had finished the Tractatus, Wittgenstein told Russell that the main contention of the book, to which all else, including the account of logic, is subsidiary, ‘is the theory of what can be expressed (gesagt) by prop[osition]s -- i.e. by language -- (and, which comes to the same, what can be thought) and what cannot be expressed by prop[osition]s, but only shown (gezeigt); (...) which I believe is the cardinal problem of philosophy’ (CL 68). This was emphasized in both preface and conclusion of the book. The preface observes that the whole sense of the book can be summed up in the following words: ‘what can be said at all can be said clearly, and what we cannot talk about we must pass over in silence’ (TLP p.3). The conclusion of the book (TLP 7) simply repeats this. The preceding three remarks, however, are noteworthy. They make three claims. First, ‘There are, indeed, things that cannot be put into words. They make themselves manifest. They are what is mystical’ (TLP 6.522). This reiterates the leitmotif of the book, namely that there are things that cannot, by the very nature of representation, be said. But though they cannot be said, they are shown by features of the relevant system of representation. Secondly, the correct method in philosophy would really be to say nothing except what can be said, i.e. empirical propositions that have nothing to do with philosophy, and then, when someone wanted to say something metaphysical, to demonstrate to him that he had failed to give meaning to certain signs in his propositions (TLP 6.53). This method, of course, is not the method that has been followed throughout the book, which consists almost exclusively of modal assertions concerning what must, can or cannot be thus and so in reality, in language and in the relation between language and reality.. (shrink)

1. Naturalism Naturalism, it has been said, is the distinctive development in philosophy over the last thirty years. There has been a naturalistic turn away from the a priori methods of traditional philosophy to a conception of philosophy as continuous with natural science. The doctrine has been extensively discussed and has won considerable following in the USA. This is, on the whole, not true of Britain and continental Europe, where the pragmatist tradition never took root, and the temptations of scientism (...) in philosophy were less alluring. Contemporary American naturalism originates in the writings of Quine, the metaphysician of twentieth-century science. With extraordinary panache, he painted a largescale picture of human nature, of language and of the web of belief. I believe that in almost every major respect, it is, like the picture painted by Descartes, the great metaphysician of seventeenth-century science, mistaken. But it evidently appeals to the spirit of the times. So it is worthy of critical examination and careful refutation. I shall argue that the naturalistic turn is a cul-de-sac – a turn that is to be passed by if we are to keep to the highroad of good sense. Naturalism, like so many of Quine’s doctrines, was propounded in response to Carnap. As Quine understood matters, Carnap had been persuaded by Russell’s Our Knowledge of the External World that it is the task of philosophy to demonstrate that our knowledge of the external world is a logical construction out of, and hence can be reduced to, elementary experiences. Quine rejected the reductionism of Carnap’s Logischer Aufbau, and found the idealist basis uncongenial to his own dogmatic realist behaviourism, inspired by Watson and later reinforced by Skinner. The rejection of reductionism and ‘unregenerate realism’, Quine averred, were the sources of his naturalism (FME 72). What exactly was this? We can distinguish in Quine between three different but inter-related programmes for future philosophy: epistemological, ontological and philosophical naturalism. Naturalized epistemology is to displace traditional epistemology, transforming the investigation into ‘an enterprise within natural science’ (NNK 68) – a psychological enterprise of investigating how the ‘input’ of radiation, etc., impinging on the nerve endings of human beings can ‘ultimately’ result in an ‘output’ of our theoretical descriptions of the external world.. (shrink)

1. First person authority: the received explanation Over a wide range of psychological attributes, a mature speaker seems to enjoy a defeasible form of authority on how things are with him. The received explanation of this is epistemic, and rests upon a cognitive assumption. The speaker’s word is a authoritative because when things are thus-and-so with him, then normally he knows that they are. This is held to be because the speaker has direct and privileged access to the contents of (...) his consciousness by means of introspection, conceived as a faculty of inner sense. Like perceptual knowledge, introspective knowledge is held to be direct and non-evidential. Accordingly, the first-person utterances ‘I have a pain’, ‘I believe that p’, ‘I intend to V’ are taken to be descriptions of what is evident to inner sense. Many classical thinkers held such subjective knowledge to be not only immediate, but also infallible and indubitable. The challenge to the received conceptions came from Wittgenstein. He denied the cognitive assumption, arguing that it cannot be said of me at all (except perhaps as a joke) that I know that I am in pain. For what is that supposed to mean — except perhaps that I am in pain?1 If it makes no sense to say that one knows that one is in pain, then the epistemic explanation is a non-starter, since it explains the special authoritative status of a person’s avowal of pain by reference to the putative fact that the subject of pain knows, normally knows, or cannot but know, that he is in pain when he is. It is important to note that Wittgenstein did not mechanically generalize the case of pain across the whole domain of firstperson utterances. The case of pain constitutes only one pole of a range of such utterances. Avowals and averrals of belief and intention approximate the other pole, and require independent analysis and grammatical description. (shrink)

The author discusses an inscription of the late fourth or early third century BC carved on a bronze plaque found in the first excavations at Dodona, on which a Zakynthian, by name Agathon, records a link of proxeny between himself and his family and the Epirote koinon of the Molossians, through Kassandra, the Trojan prophetess. The plaque is decorated by a prominent phallus with testicles, which the author interprets as referring to the continuity, past and future, of the "geneá" of (...) Agathon. Other explanations of the whole piece have been proposed, and the present essay is intended only to explore the possibility of this interpretation. (shrink)

1. _The project_ Over the last two and a half centuries three main strands of opinion can be discerned in philosophers.

This is a new edition of the first volume of G.P.Baker and P.M.S. Hacker’s definitive reference work on Wittgenstein’s _Philosophical Investigations_. New edition of the first volume of the monumental four-volume _Analytical Commentary on the Philosophical Investigations._ Takes into account much material that was unavailable when the first edition was written. Following Baker’s death in 2002, P.M.S. Hacker has thoroughly revised the first volume, rewriting many essays and sections of exegesis completely. Part One - the Essays - now includes two (...) completely new essays: 'Meaning and Use' and 'The Recantation of a Metaphysician'. Part Two - Exegesis §§1-184 - has been thoroughly revised in the light of the electronic publication of Wittgenstein’s _Nachlass_, and includes many new interpretations of the remarks, a history of the composition of the book, and an overview of its structure. The revisions will ensure that this remains the definitive reference work on Wittgenstein’s masterpiece for the foreseeable future. (shrink)

This chapter contains section titled: Baker's New Conception Waismann and Wittgenstein Wittgenstein on the Psychoanalytic Analogy Wittgenstein's Methodology Reconsidered Wittgenstein and Ryle 1: Categorial Confusions Wittgenstein and Ryle 2: Logical Geography Baker's Wittgenstein.

This is a much revised and extended new edition of _Part I_ of the first volume of the monumental four-volume _Analytical Commentary on the Philosophical Investigations_. Takes into account much new material that was unavailable when the first edition was written Following Baker’s death in 2002, P.M.S. Hacker has rewritten many essays completely _Part I: Essays_ now includes two completely new essays: 'Meaning and Use' and 'The Recantation of a Metaphysician'; the essays: ‘The Augustinian Conception of Language’, ‘The Language-Game Method’, (...) ‘Contextual Dicta and Contextual Principles’, ‘Philosophy’, ‘Surveyability and Surveyable Representations’, and ‘Truth and the General Propositional Form’ are redrafted and expanded, incorporating new source materials and new arguments, as well as taking into account debates of the last quarter of a century The accompanying _Part II: Exegesis §§1-184_ - has been thoroughly revised in the light of the electronic publication of Wittgenstein’s _Nachlass_, and includes many new interpretations of the remarks, a history of the composition of the _Philosophical Investigations_ and an overview of its structure. The revisions will ensure that this remains the definitive reference work on Wittgenstein’s masterpiece for the foreseeable future. (shrink)

1. Belief and mental statesDavidson holds that intentional verbs occurring in the form ‘A Vs that p’ signify propositional attitudes. These are, he claims, mental states, and dispositions. Davidson does not conceive of himself as introducing a special technical sense of the common intentional verbs. He insists that ‘the mental states in question are beliefs, desires, intentions, and so on, as ordinarily conceived'. Consequently he contends that believing that p is a mental state, disposition or dispositional state. These ontological claims (...) about the nature of belief inform his account of the logical form of belief sentences. I shall address the question of whether believing that p can justly be deemed a mental state, a disposition or dispositional state. Subsequently I shall examine Davidson's account of the logical form of belief sentences.Our concept of a mental state, like so many of the concepts which philosophers treat as categorial, is none too sharply defined. It has a respectable use, which can be described. But, like other such general psychological terms, e.g. ‘mental process’, ‘mental activity’, far from being the ‘hardest of the hard’ - a sharply circumscribed categorial term akin to a variable in a well-constructed formal system — it has blurred boundaries and is elastic. Like all our ordinary psychological concepts, it evolved in order to meet everyday needs. As Wittgenstein observed, ‘The concepts of psychology are just everyday concepts. They are not concepts newly fashioned by science for its own purposes, as are the concepts of physics and chemistry.’Although our ordinary concepts can be replaced by technical ones for specialized purposes, they cannot be abused without generating conceptual confusion and incoherence. If the expression ‘mental state’ is being employed in its ordinary sense, then it is wrong to hold that believing that p is to be in any mental state. If it is being employed in a special technical sense, then those who employ it thus owe us an account of what it means and how it is to be used. This Davidson and the many other philosophers who subscribe to the view that believing is a mental state have not done. Until such an account is forthcoming, one may presume that they think of themselves as deploying our ordinary concept of a mental state. And if so, I shall argue, they are misusing it. (shrink)

There is a vast amount of evidence across countries that the use of health care services (including hospitalizations, physician services, and clinical preventive services) is positively associated with income, education and other markers of socioeconomic position. In some analyses, lower socioeconomic status (SES) is associated with greater physician and hospital use, although it appears that these findings are primarily driven by higher rates of poor health status or medical need in socioeconomically disadvantaged populations. Three general sets of explanations have been (...) investigated to explain SES differences in health care use: (1) financial access or affordability differences (e.g. the poor use fewer services because they have fewer financial means); (2) knowledge, attitudinal and cultural differences in seeking care (e.g. the poor use fewer services because they value and/or understand the benefits of health care less than other people); and (3) health care system factors (e.g. the poor use fewer services because of ways in which the health care system is organized). The empirical evidence from a number of countries suggests that health care system variables, especially non-financial components of access, offer the greatest explanatory power regarding SES differences in utilization. The policy implications of such findings are important, for they suggests that providing universal coverage or offering free health services to the poor is not a panacea for reducing social inequalities in health care utilization. Research across countries also suggests that, although SES differences in the use of health care services may contribute to some portion of observed SES disparities in health status, the contribution here is likely to be small. Social inequalities in health status are driven by myriad factors other than access to and use of personal health services. (shrink)

Some 20 years ago Todd and colleagues proposed that rhythm perception is mediated by the conjunction of a sensory representation of the auditory input and a motor representation of the body (Todd, 1994a, 1995 ), and that a sense of motion from sound is mediated by the vestibular system (Todd, 1992a, 1993b ). These ideas were developed into a sensory-motor theory of rhythm and beat induction (Todd et al., 1999 ). A neurological substrate was proposed which might form the biological (...) basis of the theory (Todd et al., 2002 ). The theory was implemented as a computational model and a number of experiments conducted to test it. In the following time there have been several key developments. One is the demonstration that the vestibular system is primal to rhythm perception, and in related work several experiments have provided further evidence that rhythm perception is body dependent. Another is independent advances in imaging, which have revealed the brain areas associated with both vestibular processing and rhythm perception. A third is the finding that vestibular receptors contribute to auditory evoked potentials (Todd et al., 2014a, b ). These behavioral and neurobiological developments demand a theoretical overview which could provide a new synthesis over the domain of rhythm perception. In this paper we suggest four propositions as the basis for such a synthesis. (1) Rhythm perception is a form of vestibular perception; (2) Rhythm perception evokes both external and internal guidance of somatotopic representations; (3) A link from the limbic system to the internal guidance pathway mediates the “dance habit”; (4) The vestibular reward mechanism is innate. The new synthesis provides an explanation for a number of phenomena not often considered by rhythm researchers. We discuss these along with possible computational implementations and alternative models and propose a number of new directions for future research. (shrink)

L'examen des diverses combinaisons des ordres des évangiles et des ordres bibliques des Quatre Vivants permet de montrer que l'identification des évangélistes avec les Vivants a visé d'abord à exprimer l'unité de l'Évangile un et quatre avant de caractériser leurs différences. Trois systèmes ont prévalu dans l'antiquité. Dans le plus ancien, Marc est identifié à l'Aigle ; dans un autre système, Marc est identifié à l'Homme ; dans le système reçu, finalement Marc est identifié au Lion . A l'origine, l'Apocalypse (...) est le lieu biblique fondamental, mais en Orient puis en Occident, Ézéchiel supplante l'Apocalypse. La conjonction de l'ordre reçu des évangiles et de la séquence des Vivants en Ez 1,10 a donné le système habituel depuis S. Jérôme: Mt = Homme; Mc = Lion; Lc = Taureau; Jn = Aigle. (shrink)

This is a new edition of the first volume of G.P.Baker and P.M.S. Hacker’s definitive reference work on Wittgenstein’s _Philosophical Investigations_. Takes into account much material that was unavailable when the first edition was written. Following Baker’s death in 2002, P.M.S. Hacker has thoroughly revised the first volume, rewriting many essays and sections of exegesis completely. Part One – the Essays – now includes two completely new essays: 'Meaning and Use' and 'The Recantation of a Metaphysician'. Part Two – Exegesis (...) §§1–184 – has been thoroughly revised in the light of the electronic publication of Wittgenstein’s _Nachlass_, and includes many new interpretations of the remarks, a history of the composition of the book, and an overview of its structure. The revisions will ensure that this remains the definitive reference work on Wittgenstein’s masterpiece for the foreseeable future. (shrink)

Stakeholder theory is a pertinent example of a framework that has been stretched over many conceptual contexts and that has been applied to a wide variety of empirical phenomena. A pressing issue involves the scope of application of stakeholder theory, however, because it is not a comprehensive ethical scheme or problem-solving algorithm. We begin our search for the boundaries of stakeholder management by identifying a presently under-acknowledged yet major underlying assumption, notably that the approach is rooted in voluntary action and (...) association. Building on this presumption, we argue that firm - stakeholder relationships are best to be understood in contractualist terms; i.e. as voluntary arrangements between two or more parties seeking mutual benefit. This assertion subsequently allows us to identify three boundary conditions applying to stakeholder theory: (1) the parties should be sufficiently autonomous; (2) their interests need to be alignable; and (3) they should be capable of living up to their commitments. We substantiate these criteria with evidence from a collective case study of buyer - supplier relationships in the Dutch manufacturing sector, demonstrating that the stakeholder management model fails when these boundary criteria are violated. (shrink)

This is a much revised and extended new edition of _Part II_ of the first volume of the monumental four-volume _Analytical Commentary on the Philosophical Investigations_. Takes into account much new material that was unavailable when the first edition was written Following Baker’s death in 2002, P.M.S. Hacker has rewritten many sections of exegesis completely _Part II: Exegesis §§1-184_ has been thoroughly revised in the light of the electronic publication of Wittgenstein’s _Nachlass_, and includes many new interpretations of the remarks, (...) a history of the composition of the _Philosophical Investigations_ and an overview of its structure The accompanying _Part I: Essays_ now includes two completely new essays: 'Meaning and Use' and 'The Recantation of a Metaphysician'; the essays: ‘The Augustinian Conception of Language’, ‘The Language-Game Method’, ‘Contextual Dicta and Contextual Principles’, ‘Philosophy’, ‘Surveyability and Surveyable Representations’, and ‘Truth and the General Propositional Form’ are redrafted and expanded, incorporating new source materials and new arguments, as well as taking into account debates of the last quarter of a century The revisions will ensure that this remains the definitive reference work on Wittgenstein’s masterpiece for the foreseeable future. (shrink)

This is a new edition of the first volume of G.P.Baker and P.M.S. Hacker’s definitive reference work on Wittgenstein’s _Philosophical Investigations_. Takes into account much material that was unavailable when the first edition was written. Following Baker’s death in 2002, P.M.S. Hacker has thoroughly revised the first volume, rewriting many essays and sections of exegesis completely. Part One – the Essays – now includes two completely new essays: 'Meaning and Use' and 'The Recantation of a Metaphysician'. Part Two – Exegesis (...) §§1–184 – has been thoroughly revised in the light of the electronic publication of Wittgenstein’s _Nachlass_, and includes many new interpretations of the remarks, a history of the composition of the book, and an overview of its structure. The revisions will ensure that this remains the definitive reference work on Wittgenstein’s masterpiece for the foreseeable future. (shrink)

Inactivation of the Ca2+ extrusion mode of the retinal rod Na- Ca + K exchanger is suggested to be the mechanism that prevents lowering of cytosolic free Ca2+ to < 1 nM when rod cells are saturated for a prolonged time under bright light conditions. Under these conditions, Ca2+ fluxes across disk membranes can contribute significantly to Ca2+ homeostasis in rods.

Background:Surveillance technology such as tag and tracking systems and video surveillance could increase the freedom of movement and consequently autonomy of clients in long-term residential care settings, but is also perceived as an intrusion on autonomy including privacy.Objective:To explore how clients in residential care experience surveillance technology in order to assess how surveillance technology might influence autonomy.Setting:Two long-term residential care facilities: a nursing home for people with dementia and a care facility for people with intellectual disabilities.Methods:Ethnographic field study.Ethical considerations:The boards (...) representing clients and relatives/proxies of the clients were informed of the study and gave their written consent. The clients’ assent was sought through a special information leaflet. At any time clients and/or proxy were given the option to withdraw from the study. The research protocol was also reviewed by a medical ethics committee.Findings:Our findings show a pattern of two themes: (1) coping with new spaces which entailed clients: wandering around, getting lost, being triggered, and retreating to new spaces and (2) resisting the surveillance technology measure because clients feel stigmatized, missed the company, and do not like being “watched.”Conclusion:Client experiences of surveillance technology appear to entail a certain ambivalence. This is in part due to the variety in surveillance technology devices, with each device bringing its own connotations and experiences. But it also lies in the devices’ presupposition of an ideal user, which is at odds with the actual user who is inherently vulnerable. Surveillance technology can contribute to the autonomy of clients in long-term care, but only if it is set in a truly person-centered approach. (shrink)

BackgroundHuntington’s disease has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive. Little is known about the perspectives of HD patients on their AED.AimTo gain insight into patients’ views on and attitudes towards their AED, and changes over time.MethodsA longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients who either had an AED or (...) were thinking about drawing it up participated in this study.ResultsWe identified two themes that characterize patients’ perspectives on their AEDs: general character of the AED; uncertainty around their AED. Ad The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED.ConclusionHD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care. (shrink)

We used computer simulations to study the possible role of the dispersion of cellular coupling, refractoriness or both, in the mechanisms underlying cardiac arrhythmias. Local ischemia was first assumed to induce cell to cell dispersion of the coupling resistance (Case 1), refractory period (Case 2), or both of them (Case 3). Our numerical experiments based on the van Capelle and Durrer model showed that vortices could not be induced by cell to cell variations. With cellular properties dispersed in a patchy (...) way within the ischemic zone, a single activation wave could give rise to abnormal activities. This demonstrates the stability of the wave front under small inhomogeneities. Probabilities of reentry, estimated for the three cases cited above showed that a severe alteration of the coupling resistance may be an important factor in the genesis of reentry. Moreover, use of isochronal maps revealed that vortices were both stable and sustained with an alteration of the coupling alone or combined with a reduction of the action potential duration. Conversely, simulations with reduction of the refractoriness alone, inducing only transient patterns, could exhibit functionally determined reentries. (shrink)

(1984). Performance-Enhancing Drugs in Sport: The Ethical Issue. Journal of the Philosophy of Sport: Vol. 11, No. 1, pp. 23-28. doi: 10.1080/00948705.1984.9714410.