Medical discourse in the contemporary United States is rife with military metaphors. These metaphors have come under vigorous criticism over the last few decades but to no avail; the militaristic tendency has proven tenacious. This essay suggests that its tenacity stems, at least in part, from a dualistic understanding of medicine unaddressed by prior criticisms. For an alternative, this essay turns to Augustine of Hippo, balancing close readings of works that deal explicitly with medical themes—The Catholic Way of Life and (...) the Manichean Way of Life (De moribus) and The Nature of the Good (De natura boni)—with a constructive approach. By adapting Augustine's privative account of evil, we can understand disease as a condition of loss and treatment as a task of restoration. This reconfiguration shifts the focus of our interpretive discourses from malicious invaders to a fuller affirmation of the lived experiences of those who are ill. (shrink)

The model of atonement presented in Anselm of Canterbury's Cur Deus Homo has aroused a host of worries from theologians. The gist of their criticism is that Anselm inscribes redemptive violence into theology and thus encourages passive acquiescence to abusive power structures or even licenses the violence of abusers. Some suggest that the way forward would be to jettison Anselm's account and develop alternatives that are not liable to the same abuses. This paper argues that while alternatives may be desirable, (...) Cur Deus Homo looms so large in theological imaginations as to defy jettisoning. We should instead try to perform better readings. This paper presents a close reading of this text as a monastic meditation on mortality oriented less toward resolving a problem of systematic theology than drawing readers into a renewed experience of devotion to God. To do that, Anselm works to rewrite the meaning of human mortality, making it less about the necessity of losing one's life and more about the possibility of a gift of death. The ethical paradigm that emerges is far from a complete moral vision, but is still more alluring than the one about which Anselm's contemporary critics worry. (shrink)

Adaptive immunity is unique to the vertebrates, and the molecules involved (including immunoglobulins, T cell receptors and the major histocompatibility complex molecules) seem to have diversified very rapidly early in vertebrate history. Reconstruction of gene phylogenies has yielded insights into the evolutionary origin of a number of molecular systems, including the complement system and the major histocompatibility complex (MHC). These analyses have indicated that the C5 component of complement arose by gene duplication prior to the divergence of C3 and C4, (...) which suggests that the alternative complement pathway was the first to evolve. In the case of the MHC, phylogenetic analysis supports the hypothesis that MHC class II molecules evolved before class I molecules. The fact that the MHC‐linked proteasome components that specifically produce peptides for presentation by class I MHC appear to have originated before the separation of jawed and jawless vertebrates suggests that the MHC itself may have been present at this time. Immmune system gene families have evolved by gene duplication, interlocus recombination and (in some cases) positive Darwinian selection favoring diversity at the amino acid level. (shrink)

The greatest philosopher of the twentieth century may not have been Wittgenstein, or Russell, or Quine (and he certainly wasn’t Heidegger), but he may have been a somewhat obscure and conservative Australian named David Stove (1927-94). If he wasn’t the greatest philosopher of the century, Stove was certainly the funniest and most dazzling defender of common sense to be numbered among the ranks of last century’s thinkers, better even—by far—than G. E. Moore and J. L. Austin. The twentieth century (...) was not a period in which philosophers distinguished themselves as essayists, or even as capable of writing interestingly on any subject outside their speciality (or even within it). Stove, though, was an essayist, polemicist, and wit of the highest order, rather like a super-intelligent H. L. Mencken. A heavyweight admirer was once led to write that “Reading Stove is like watching Fred Astaire dance. You don’t wish you were Fred Astaire, you are just glad to have been around to see him in action.”. (shrink)

SummaryThe Gainj of highland Papua New Guinea do not use contraception but have a total fertility rate of only 4·3 live births per woman, one of the lowest ever recorded in a natural fertility setting. From an analysis of cross-sectional demographic and endocrinological data, the causes of low reproductive output have been identified in women of this population as: late menarche and marriage, a long interval between marriage and first birth, a high probability of widowhood at later reproductive ages, low (...) effective fecundability and prolonged lactational amenorrhoea. These are combined with near-universal marriage, a low prevalence of primary sterility and a pattern of onset of secondary sterility similar to that found in other populations. Of all the factors limiting fertility, by far the most important are those involved in birth spacing, especially lactational amenorrhoea. (shrink)

SummaryThe effects of infant suckling patterns on the post-partum resumption of ovulation and on birth-spacing are investigated among the Gainj of highland New Guinea. Based on hormonal evidence, the median duration of lactational anovulation is 20·4 months, accounting for about 75% of the median interval between live birth and next successful conception. Throughout lactation, suckling episodes are short and frequent, the interval changing slowly over time, from 24 minutes in newborns to 80 minutes in 3-year olds. Maternal serum prolactin concentrations (...) decline in parallel with the changes in suckling patterns, approaching the level observed in non-nursing women by about 24 months post-partum. A path analysis indicates that the interval between suckling episodes is the principal determinant of maternal prolactin concentration, with time since parturition affecting prolactin secretion only in so far as it affects suckling frequency. The extremely prolonged contraceptive effect of breast-feeding in this population thus appears to be due to a slow decline in suckling frequency with time since parturition and absence of a decline over time in hypothalamic–pituitary responsiveness to the suckling stimulus. (shrink)

BackgroundThe objective of this study was to evaluate the nature and extent of reproducible and transparent research practices in neurology publications.MethodsThe NLM catalog was used to identify MEDLINE-indexed neurology journals. A PubMed search of these journals was conducted to retrieve publications over a 5-year period from 2014 to 2018. A random sample of publications was extracted. Two authors conducted data extraction in a blinded, duplicate fashion using a pilot-tested Google form. This form prompted data extractors to determine whether publications provided (...) access to items such as study materials, raw data, analysis scripts, and protocols. In addition, we determined if the publication was included in a replication study or systematic review, was preregistered, had a conflict of interest declaration, specified funding sources, and was open access.ResultsOur search identified 223,932 publications meeting the inclusion criteria, from which 400 were randomly sampled. Only 389 articles were accessible, yielding 271 publications with empirical data for analysis. Our results indicate that 9.4% provided access to materials, 9.2% provided access to raw data, 0.7% provided access to the analysis scripts, 0.7% linked the protocol, and 3.7% were preregistered. A third of sampled publications lacked funding or conflict of interest statements. No publications from our sample were included in replication studies, but a fifth were cited in a systematic review or meta-analysis.ConclusionsCurrently, published neurology research does not consistently provide information needed for reproducibility. The implications of poor research reporting can both affect patient care and increase research waste. Collaborative intervention by authors, peer reviewers, journals, and funding sources is needed to mitigate this problem. (shrink)

First published in 1962, contains the William James Lectures delivered at Harvard University in 1955. It sets out Austin's conclusions in the field to which he directed his main efforts for at least the last ten years of his life. Starting from an exhaustive examination of his already well- known distinction of performative utterances from statements, Austin here finally abandons that distinction, replacing it by a more general theory of 'illocutionary forces' of utterances which has important bearings on (...) a wide variety of philosophical problems. (shrink)

McCoy and colleagues (2023) offer a reflective framework for data ethics and governance with several historical bioethics principles as a foundation. Their framework is one among a plethora of othe...

Humanitarian health care practitioners working outside familiar settings, and without familiar supports, encounter ethical challenges both familiar and distinct. The ethical guidance they rely upon ought to reflect this. Using data from empirical studies, we explore the strengths and weaknesses of two ethical models that could serve as resources for understanding ethical challenges in humanitarian health care: clinical ethics and public health ethics. The qualitative interviews demonstrate the degree to which traditional teaching and values of clinical health ethics seem insufficient (...) for addressing all the realities of health care practice during humanitarian missions. They equally suggest that greater good orientations of public health ethics can thwart the best intentions of health care professionals wanting to attend to the interests of individual patients. Even though neither is complete on its own for helping guide health professionals on field missions, taken together these models have much to offer. At the same time, the narratives of the humanitarian health care workers illustrate how some of the crucial differences between public health ethics and clinical ethics generate tensions in humanitarian health practice. We offer an analysis of some of the complexities this creates for humanitarian health care ethics, and consider ways of adjudicating between the two models. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Business Ethics: A European Review, EarlyView.

_The Foundations of Arithmetic_ is undoubtedly the best introduction to Frege's thought; it is here that Frege expounds the central notions of his philosophy, subjecting the views of his predecessors and contemporaries to devastating analysis. The book represents the first philosophically sound discussion of the concept of number in Western civilization. It profoundly influenced developments in the philosophy of mathematics and in general ontology.

Taking Rom Harré's social constructionism as a focus we point to and discuss the issue of the a priori psychological subject in social constructionist theory. While Harré indicates that interacting, intending beings are necessary for conversation to occur, he assumes that the primary human reality is conversation and that psychological life emerges from this social domain. Nevertheless, we argue that a fundamental and agentive psychological subject is implicit to his constructionist works. Our critical analyses focus upon Harré's understandings of persons, (...) human development and human agency. Our intention is neither to suggest that this latent entity must be understood in a Cartesian sense nor is it to ask for an explicit accounting of an autonomous agent. Rather, our claim is simply that psychological subjectivity is reflexively entailed in Harré's human psychology. We suggest that this pertains more generally to social constructionist theory. (shrink)

Factors such as subsistence turnover, warfare, or interaction between different groups can be major sources of cultural change in human populations. Global demographic shifts such as the transition to agriculture during the Neolithic and more recently the urbanization and globalization of the twentieth century have been major catalysts for cultural change. Here, we test whether cultural traits such as patri/matrilocality and postmarital migration persist in the face of social upheaval and gene flow during the past 150 years in postcolonial South (...) Africa. The recent history of South Africa has seen major demographic shifts that resulted in the displacement and forced sedentism of indigenous Khoekhoe and San populations. During the expansion of the colonial frontier, the Khoe-San admixed with European colonists and enslaved individuals from West/Central Africa, Indonesia, and South Asia, introducing novel cultural norms. We conducted demographic interviews among Nama and Cederberg communities representing nearly 3,000 individuals across three generations. Despite the history of colonial expansion, and the subsequent incorporation of Khoe-San and Khoe-San-descendant communities into a colonial society with strong patrilocal norms, patrilocality is the least common postmarital residence pattern in our study populations today. Our results suggest that more recent forces of integration into the market economy are likely the primary drivers of change in the cultural traits examined in our study. Birthplace had a strong effect on an individual’s odds of migration, distance moved, and postmarital residence form. These effects are at least partially explained by the population size of the birthplace. Our results suggest that market factors local to birthplaces are important drivers of residence decisions, although the frequency of matrilocal residence and a geographic and temporal cline in migration and residence patterns also indicate the persistence of some historic Khoe-San cultural traits in contemporary groups. (shrink)

This book brings together scholarship on three different forms of state violence, examining each for what it can tell us about the conditions under which states use violence and the significance of violence to our understanding of states. This book calls into question the legitimacy of state uses of violence and mounts a sustained effort at interpretation, sense making, and critique. It suggests that condemning the state's decisions to use lethal force is not a simple matter of abolishing the death (...) penalty or – to take another exemplary example of the killing state – demanding that the state engage only in just wars, pointing out that even such overt instances of lethal force are more elusive as targets of critique than one might think. Indeed, altering such decisions may do little to change the essential relationship of the state to violence. (shrink)

It is often argued that the indispensability of continuum models comes from their empirical adequacy despite their decoupling from the microscopic details of the modelled physical system. There is thus a commonly held misconception that temperature varying across a region of space or time can always be accurately represented as a continuous function. We discuss three inter-related cases of temperature modelling — in phase transitions, thermal boundary resistance and slip flows — and show that the continuum view is fallacious on (...) the ground that the microscopic details of a physical system are not necessarily decoupled from continuum models. We show how temperature discontinuities are present in both data (experiments and simulations) and phenomena (theory and models) and how discontinuum models of temperature variation may have greater empirical adequacy and explanatory power. The conclusions of our paper are: a) continuum idealisations are not indispensable to modelling physical phenomena and both continuous and discontinuous representations of phenomena work depending on the context; b) temperature is not necessarily a continuously defined function in our best scientific representations of the world; and c) that its continuity, where applicable, is a contingent matter. We also raise a question as to whether discontinuous representations should be considered truly de-idealised descriptions of physical phenomena. (shrink)

Marine ecosystems are under increasing pressure from human activity, yet successful management relies on knowledge. The evidence-based policy (EBP) approach has been promoted on the grounds that it provides greater transparency and consistency by relying on ‘high quality’ information. However, EBP also creates epistemic responsibilities. Decision-making where limited or no empirical evidence exists, such as is often the case in marine systems, creates epistemic obligations for new information acquisition. We argue that philosophical approaches can inform the science-policy interface. Using marine (...) biosecurity examples, we specifically examine the epistemic challenges in the acquisition and acceptance of evidence to inform policy, discussing epistemic due care and biases in consideration of evidence. (shrink)