BackgroundFamily presence during adult cardiopulmonary resuscitation is still not widely implemented. Based on empirical evidence, various national and international professional organizations recommend allowing relatives to be present during resuscitation. However, healthcare providers worldwide are still reluctant to make it standard care.PurposeThis paper is a part of an ongoing cross-cultural study that aims to solicit attitudes of healthcare providers working in emergency departments towards family presence during cardiopulmonary resuscitation. This paper reports the qualitative data from surveying healthcare providers working in an (...) emergency department at a university-affiliated hospital in Singapore.MethodHealthcare workers were asked to fill out an online survey, including both quantitative and qualitative questions. Their attitudes were critically analyzed and compared with existing empirical data.ResultsMajority of healthcare workers believed that relatives should not be present during c... (shrink)

Genetic testing for cancer susceptibility is an application of biotechnology that has the potential both to improve the psychosocial and physical wellbeing of the population and to cause significant psychosocia1 and physical harms. In spite of the uncertain value of genetic testing, it has captured the interest of biotechnology companies, researchers, health care providers, and the public. As more tests become feasible, pressure may increase to make the tests available and reimbursable. Both the benefits and harms of these tests lie (...) not as much in the tests themselves, as in their power to predict or alter the future. The value of the tests does not derive from the information per se, but from the ability to communicate effectively the information to patients and providers, and the behavioral responses of patients, providers, and others to this information. (shrink)

Genetic testing for cancer susceptibility is an application of biotechnology that has the potential both to improve the psychosocial and physical wellbeing of the population and to cause significant psychosocia1 and physical harms. In spite of the uncertain value of genetic testing, it has captured the interest of biotechnology companies, researchers, health care providers, and the public. As more tests become feasible, pressure may increase to make the tests available and reimbursable. Both the benefits and harms of these tests lie (...) not as much in the tests themselves, as in their power to predict or alter the future. The value of the tests does not derive from the information per se, but from the ability to communicate effectively the information to patients and providers, and the behavioral responses of patients, providers, and others to this information. (shrink)

An English language translation accompanies the original Greek text of Aristotle's book about the nature of the state, constitutions, revolutions, democracy, and oligarchy.

Rosenzweig's Bible examines the high stakes, both theological and political, of Franz Rosenzweig's attempt to revivify the Hebrew Bible and use it as the basis for a Jewish textual identity. Mara Benjamin's innovative reading of The Star of Redemption places Rosenzweig's best-known work at the beginning of an intellectual trajectory that culminated in a monumental translation of the Bible, thus overturning fundamental assumptions that have long guided the appraisal of this titan of modern Jewish thought. She argues that Rosenzweig's (...) response to modernity was paradoxical: he challenged his readers to encounter the biblical text as revelation, reinventing scripture – both the Bible itself and the very notion of a scriptural text – in order to invigorate Jewish intellectual and social life, but did so in a distinctly modern key, ultimately reinforcing the foundations of German-Jewish post-Enlightenment liberal thought. Rosenzweig's Bible illuminates the complex interactions that arise when modern readers engage the sacred texts of ancient religious traditions. (shrink)

While the bioethics literature demonstrates that the field has spent substantial time and thought over the last four decades on the goals, methods, and desired outcomes for service and training in bioethics, there has been less progress defining the nature and goals of bioethics research and scholarship. This gap makes it difficult both to describe the breadth and depth of these areas of bioethics and, importantly, to gauge their success. However, the gap also presents us with an opportunity to define (...) this scope of work for ourselves and to help shape the broader conversation about the impact of academic research. Because of growing constraints on academic funding, researchers and scholars in many fields are being asked to demonstrate and also forecast the value and impact of their work. To do that, and also to satisfy ourselves that our work has meaningful effect, we must understand how our work can motivate change and how that change can be meaningfully measured. In a field as diverse as bioethics, the pathways to and metrics of change will likewise be diverse. It is therefore critical that any assessment of the impact of bioethics research and scholarship be informed by an understanding of the nature of the work, its goals, and how those goals can and ought to be furthered. In this paper, we propose a conceptual model that connects individual bioethics projects to the broader goals of scholarship, describing the translation of research and scholarly output into changes in thinking, practice, and policy. One of the key implications of the model is that impact in bioethics is generally the result of a collection of projects rather than of any single piece of research or scholarship. Our goal is to lay the groundwork for a thoroughgoing conversation about bioethics research and scholarship that will advance and shape the important conversation about their impact. (shrink)

In this paper I untangle a recent debate in the philosophy of epidemiology, focusing in particular on the Potential Outcomes Approach to causation. As the POA strategy includes the quantification of ‘contrary-to-fact’ outcomes, it is unsurprising that it has been likened to the counterfactual analysis of causation briefly proposed by David Hume, and later developed by David Lewis. However, I contend that this has led to much confusion. Miguel Hernan and Sarah Taubman have recently argued that meaningful causal inferences cannot (...) be drawn from obesity. This paper prompted Alex Broadbent to criticise the POA conception of causation, accusing two of the four theses its proponents are committed to, of circularity and falsity. Here I scrutinise Broadbent’s claims, and suggest that a Popperian approach to causal inference in epidemiology diffuses both of his objections. However, I move on to argue that the POA’s commitment to granting only manipulable conditions causal-status, renders the position implausible as a conceptual analysis of causation. That said, I conclude that the strategy the POA employs is an effective tool for effect-measurement in intervention-cases; if it is a conceptual analysis of causation at all, it must be restricted to the causal analysis of manipulable conditions. The POA’s failure to successfully demarcate causal from non-causal conditions simpliciter should therefore not be viewed as a serious threat. (shrink)

Philosophy of Medicine has for a long time been preoccupied with analyzing the concepts of health, disease and illness. Relatively speaking, the concept of medicine itself has received very little attention. This paper is a contribution to the relatively neglected debate about the nature of medicine. Building on the work of Alex Broadbent (Broadbent, 2018a, b), Chadwin Harris (Harris, 2018) and Thaddeus Metz (Metz, 2018), in this paper I question the persuasiveness of Broadbent’s account of the “core business” of medicine, (...) The Inquiry Thesis, and propose an alternative: a revised version of The Curative Thesis, which I coin The Best Available Intervention Thesis. Crudely, this suggests that Medicine is the sustained and organised effort to determine and prescribe the best available treatment (curative or preventative) for patients. (shrink)

We report on the development and initial validation of the Moralization of Everyday Life Scale, designed to measure variations in people's assignment of moral weight to commonplace behaviors. In Study 1, participants reported their judgments for a large number of potential moral infractions in everyday life; principal components analysis revealed 6 main dimensions of these judgments. In Study 2, scores on the 30-item MELS showed high reliability and distinctness from the Big 5 personality traits. In Study 3, scores on the (...) MELS were strongly correlated with scores on an early scale of moral judgments, suggesting convergent validity. (shrink)

Analysts have generally offered two explanations for China's no-devaluation policy during the Asian financial crisis. The first is China's good economic fundamentals and the renminbi is not fully convertible. The second is China's foreign relations' imperative. China was endeavouring to seek favourable entry conditions into the WTO and improve relations with its Asian neighbours. At the same time it sought to exploit the undercurrent of resentment in Asia towards the role played by the US during the crisis. Policy making in (...) China has become more institutionalized in the post-Deng era, but these explanations ignore the role of China's domestic bureaucratic actors in exchange rate policy making. This paper examines the exchange rate regime preferences of China's key economic ministries and their influences in exchange rate policy making and argues that Party leaders were able to adopt a no-devaluation policy throughout the crisis because China's key economic ministries actively supported or acquiesced to that policy. (shrink)

The apostle Paul deals extensively with gender, embodiment, and desire in his authentic letters, yet many of the contemporary philosophers interested in his work downplay these aspects of his thought. _Christ Without Adam_ is the first book to examine the role of gender and sexuality in the turn to the apostle Paul in recent Continental philosophy. It builds a constructive proposal for embodied Christian theological anthropology in conversation with--and in contrast to--the "Paulinisms" of Stanislas Breton, Alain Badiou, and Slavoj Žižek. (...) Paul's letters bequeathed a crucial anthropological aporia to the history of Christian thought, insofar as the apostle sought to situate embodied human beings typologically with reference to Adam and Christ, but failed to work out the place of sexual difference within this classification. As a result, the space between Adam and Christ has functioned historically as a conceptual and temporal interval in which Christian anthropology poses and re-poses theological dilemmas of embodied difference. This study follows the ways in which the appropriations of Paul by Breton, Badiou, and Žižek have either sidestepped or collapsed this interval, a crucial component in their articulations of a universal Pauline subject. As a result, sexual difference fails to materialize in their readings as a problem with any explicit force. Against these readings, Dunning asserts the importance of the Pauline Adam-Christ typology, not as a straightforward resource but as a witness to a certain necessary failure--the failure of the Christian tradition to resolve embodied difference without remainder. This failure, he argues, is constructive in that it reveals the instability of sexual difference, both masculine and feminine, within an anthropological paradigm that claims to be universal yet is still predicated on male bodies. (shrink)

I count myself privileged to respond to Kenneth Collins and Jerry Walls recent book on Roman Catholicism. I live in Fort Worth, TX, and I am a member of Wedgwood Baptist Church, which is one of more than 40,000 churches that together comprise the Southern Baptist Convention. I mention this so readers will know that my comments come from a conservative Evangelical Protestant perspective, and my thinking stems from a tradition that is decidedly not Roman Catholic. Having said this, I’m (...) much more sympathetic to Roman Catholicism than a great many Evangelicals, including Collins and Walls. I offer my criticisms of Rome, but I ask that readers not interpret me as someone who denies that the Roman Catholic Church counts as a Christian institution. In an effort to show good faith on this front, allow me to offer some defenses of Roman Catholicism against what I take to be over the top criticisms from some Protestant Evangelicals. (shrink)

John DePoe takes issue with Christians who accept Berkeleyan idealism, essentially arguing that there is a special problem from evil for the Christian idealist. While DePoe’s treatment of idealism is commendable, his argument ultimately fails in one of two ways. It either (1) turns on common misunderstandings of idealism or (2) results in consequences unacceptable to Christians. In our article, we respond to DePoe’s argument by remotivating idealism, pointing out ways in which DePoe misunderstands idealists’ responses to the charge of (...) a special problem of evil, and pointing out problems with DePoe’s proposals of materialist solutions to the problem of evil. (shrink)

One implication of Bell’s theorem is that there cannot in general be hidden variable models for quantum mechanics that both are noncontextual and retain the structure of a classical probability space. Thus, some hidden variable programs aim to retain noncontextuality at the cost of using a generalization of the Kolmogorov probability axioms. We generalize a theorem of Feintzeig to show that such programs are committed to the existence of a finite null cover for some quantum mechanical experiments, i.e., a finite (...) collection of probability zero events whose disjunction exhausts the space of experimental possibilities. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

Current methods of obtaining an informed consent leave much to be desired. Patients rarely read consent forms or understand all of the risks, benefits, or alternatives associated with their treatment. Evaluating the advantages and disadvantages of treatment options often presents a more significant challenge for patients with lower levels of health literacy. This article reviews the evidence of shortcomings in our informed consent system and then explores the potential for a new approach to engage patients at all levels of health (...) literacy in their treatment decisions. Specifically, the article will examine the potential of shared decision-making to bridge gaps in knowledge, increase patient adherence to treatment, and improve health outcomes in low health literacy patient populations. Leveling barriers to treatment information for disadvantaged populations should be a public health imperative, especially if it can be shown to improve health outcomes and reduce health disparities. (shrink)

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future , translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize (...) factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning. (shrink)

As sophisticated artificial intelligence software becomes more ubiquitously and more intimately integrated within domains of traditionally human endeavor, many are raising questions over how responsibility (be it moral, legal, or causal) can be understood for an AI’s actions or influence on an outcome. So called “responsibility gaps” occur whenever there exists an apparent chasm in the ordinary attribution of moral blame or responsibility when an AI automates physical or cognitive labor otherwise performed by human beings and commits an error. Healthcare (...) administration is an industry ripe for responsibility gaps produced by these kinds of AI. The moral stakes of healthcare are often life and death, and the demand for reducing clinical uncertainty while standardizing care incentivizes the development and integration of AI diagnosticians and prognosticators. In this paper, we argue that (1) responsibility gaps are generated by “black box” healthcare AI, (2) the presence of responsibility gaps (if unaddressed) creates serious moral problems, (3) a suitable solution is for relevant stakeholders to voluntarily responsibilize the gaps, taking on some moral responsibility for things they are not, strictly speaking, blameworthy for, and (4) should this solution be taken, black box healthcare AI will be permissible in the provision of healthcare. (shrink)

Unlike versions of open theism that appeal to the alethic openness of the future, defenders of limited foreknowledge open theism (hereafter LFOT) affirm that some propositions concerning future contingents are presently true. Thus, there exist truths that are unknown to God, so God is not omniscient simpliciter. LFOT requires modal definitions of divine omniscience such that God knows all truths that are logically knowable. Defenders of LFOT have yet to provide an adequate response to Richard Purtill’s argument that fatalism logically (...) follows from the omnitemporality of truth. Hasker believes a distinction between hard and soft facts prevents fatalism, but I argue that his defense fails in light of arguments involving divine necessity. Additionally, I point out that Hasker’s philosophy of language concerning divine names faces problems that cannot be overcome, given the versions of the dilemma of freedom and foreknowledge that motivate LFOT. Thus, contra Hasker, Swinburne, and van Inwagen, open theism necessitates the alethic openness of the future. (shrink)

In their article, ‘Responsibility, Second Opinions, and Peer-Disagreement—Ethical and Epistemological Challenges of Using AI in Clinical Diagnostic Contexts,’ Kempt and Nagel argue for a ‘rule of disagreement’ for the integration of diagnostic AI in healthcare contexts. The type of AI in question is a ‘decision support system’, the purpose of which is to augment human judgement and decision-making in the clinical context by automating or supplementing parts of the cognitive labor. Under the authors’ proposal, artificial decision support systems which produce (...) automated diagnoses should serve chiefly as confirmatory tools; so long as the physician and AI agree, the matter is settled, and the physician’s initial judgement is considered epistemically justified. If, however, the AI-DSS and physician disagree, then a second physician’s opinion is called on to resolve the dispute. While the cognitive labour of the decision is shared between the physicians and AI, the final decision remains at the discretion of the first physician, and with it the moral and legal culpability. The putative benefits of this approach are twofold: healthcare administration can improve diagnostic performance by introducing AI-DSS without the unintended byproduct of a responsibility gap, and assuming the physician and AI disagree less than the general rate of requested second opinions, and the AI’s diagnostic accuracy supersedes or at least …. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Philosophy Can't Say About Literature:Stanley Cavell and EndgameBenjamin H. OgdenIn "Ending the Waiting Game," the philosopher of ordinary language Stanley Cavell attempts to say what Samuel Beckett's Endgame means by explaining what the characters in the play mean by what they say. Cavell attempts to do the very thing that the work says cannot be done, or mocks as foolish and misguided, or resists giving clues to how (...) it could ever be done: he tries to say just "how Beckett's objects mean at all, the original source of their conviction."1 This is not simply a reading tactic that Cavell thinks is well-suited to the difficult task of making sense of a difficult play. It is a demonstration of the theory of language (ordinary language philosophy) that Cavell defends and applies in his collection of essays Must We Mean What We Say?, of which "Ending the Waiting Game" is a chapter. Cavell's literary criticism is in the service of his philosophy. His work of criticism is in search of something that it must find (that is, something that it claims to have found even when it may not have); what it must find is a work of literature that demonstrates the utility and validity of ordinary language philosophy.If we are to take issue with Cavell for too strenuously transposing philosophy onto literature, then we must also know something of the philosophy he draws upon. Ordinary language philosophy traces its origins to Wittgenstein, and was popularized by J. L. Austin and Gilbert Ryle at Oxford in the 1940's. It is a branch of analytic philosophy that foregoes any attempt to create an "ideal philosophical language" of the sort Wittgenstein developed in his early Tractatus Logico-Philosophicus. Instead of seeing the abstractions and ambiguities of ordinary usage as something to be supplanted by a more logically rigorous system, ordinary language philosophers argue that debates over the meaning [End Page 126] of abstract terms come about precisely because words are removed from their ordinary context. For Cavell, the whole idea of an "ideal language" is absurd because, as anyone who has ever tried to learn a foreign language knows, every language has its own unique set of usages and idioms and unspoken rules. In order to speak a language properly, then, one cannot just know the dictionary or formal definitions of words (its "ideal" generative grammar), but must understand the "natural environment" in which phrases and words are logical or appropriate. Often these contexts (which determine the rules for "what we should say when" [p. 20]) invest words with meanings that you won't find in any dictionary, and cannot be catalogued in a grammatical or syntactical system.So, if one asks, "Did you dress that way voluntarily?" (p. 9), the word "voluntarily" takes on a meaning that is not included among its dictionary definitions (according to Cavell). Clearly, in asking whether you dress voluntarily one is not asking whether you have free-will to dress as you please, but is calling attention to the funny way you dress. In this case, successful communication is only possible if the one who is being questioned understands from context and the ordinary use of language precisely what is being asked. If he answers, "Of course I dressed voluntarily, I believe in free will," he will have misspoken, been incorrect. Clearly, he doesn't understand what the question must mean because the statement "MUST MEAN that my clothes are peculiar" (p. 9). For it to mean anything else would be a mistake and a misuse of language by the speaker, or a misunderstanding of language by the listener. To learn a language (which for Cavell means to become like a native speaker) is to learn the nature of the contingency between the explicit meaning of an expression and the occasion on which an expression is appropriate, and to be aware of what you must mean when you speak (what you cannot help but mean or imply by the language you use).What this means is that for Cavell reading literature becomes a process of readers "naturalizing ourselves to a new form of life, a new... (shrink)

In addition to considering sociocultural, political, economic, and ethical factors, effectively engaging socioscientific issues requires that students understand and apply scientific explanations and the nature of science. Promoting such understandings can be achieved through immersing students in authentic real-world contexts where the SSI impacts occur and teaching those students about how scientists comprehend, research, and debate those SSI. This triangulated mixed-methods investigation explored how 60 secondary students’ trophic cascade explanations changed through their experiencing place-based SSI instruction focused on the Yellowstone (...) wolf reintroduction, including scientists’ work and debates regarding that issue. Furthermore, this investigation determined the association between the students’ post place-based SSI instruction trophic cascade explanations and NOS views. Findings from this investigation demonstrate that through the place-based SSI instruction students’ trophic cascade explanations became significantly more accurate and complex and included more ecological causal mechanisms. Also, significant and moderate to moderately large correlations were found between the accuracy and contextualization of students’ post place-based SSI instruction NOS views and the complexity of their trophic cascade explanations. Empirical substantiation of the association between the complexity of students’ scientific explanations and their NOS views responds to an understudied area in the science education research. It also encourages the consideration of several implications, drawn from this investigation’s findings and others’ prior work, which include the need for NOS to be forefront alongside and in connection with science content in curricular standards and through instruction focused on relevant and authentic place-based SSI. (shrink)

Within the field of medical ethics there is a startling amount of diversity regarding which issues and relationships are deemed relevant for ethical inquiry and analysis, what strategies are appropriate for examining and resolving ethical conflict, what should be the goals for medical ethics, even who should participate in that project. What I will try to make clear in this paper is that how we go about this process of doing medical ethics, of examining, reflecting, decisionmaking, and behaving, makes a (...) practical difference, and not just a philosophical one, in terms of the understandings we will reach about ethical matters. Without attempting to resolve any of the conflicts within or between different conceptions of doing ethics, I will try to articulate the differences in orientation, and particularly the tone and educational emphasis, that attend four major contemporary approaches to ethical inquiry and analysis: deductivism, principlism, modern casuistry, and feminist/relationist ethics. Keywords: casuistry, deductivism, ethics, feminism, principlism, relationism CiteULike Connotea Del.icio.us What's this? (shrink)

In the United States, the implementation of a successful system of mandated reporting of suspected child abuse continues to be plagued by the absence of a clear standard for when one must report. All 50 states of the U.S. have laws requiring certain individuals to report suspected child abuse. However, at present, there are variable thresholds for mandated reporting and no clear consensus on how existing thresholds should be interpreted. Because “child abuse” is often present as a possible etiology for (...) injuries and non-infectious conditions that beset children, it is problematic to suggest that “the mere possibility of child abuse” qualifies as cause to report. In an effort to move toward a more effective system of mandated reporting of child maltreatment, this paper discusses how the absence of a clear threshold affects mandated reporters, examines the relevant legal and conceptual issues, and suggests future directions for policy, practice, and research. (shrink)

A father brings his six-year-old daughter and her older sister to their pediatrician to be evaluated for a history of cough, runny nose, and low-grade fever. In addition to signs of a cold, the girl's nasal bridge is quite swollen and bruised. When asked how her nose was injured, she shrugs, and her father's only conjecture is that she sleepwalks and might have bumped into something. The father sits impatiently and as questioning progresses becomes increasingly defensive, at one point angrily (...) declaring, “We don't beat our kids, if that's what you’re asking.” Further complicating the situation is information from nurses that this family is “on the brink” socially and financially, and that additional stress is likely “to blow this family apart.” A careful physical exam identifies no other injuries, and a thorough review reveals no evidence of prior suspicious injuries, frequent visits to the emergency room, or bleeding abnormalities. The evidence does not point to abuse as the most likely explanation for the injury, but it clearly is not ruled out. Should one report this family for suspected abuse? Is one required to report? (shrink)

In this consensus report by a diverse group of academics who conduct and/or are concerned about social and behavioral genomics (SBG) research, the authors recount the often‐ugly history of scientific attempts to understand the genetic contributions to human behaviors and social outcomes. They then describe what the current science—including genomewide association studies and polygenic indexes—can and cannot tell us, as well as its risks and potential benefits. They conclude with a discussion of responsible behavior in the context of SBG research. (...) SBG research that compares individuals within a group according to a “sensitive” phenotype requires extra attention to responsible conduct and to responsible communication about the research and its findings. SBG research (1) on sensitive phenotypes that (2) compares two or more groups defined by (a) race, (b) ethnicity, or (c) genetic ancestry (where genetic ancestry could easily be misunderstood as race or ethnicity) requires a compelling justification to be conducted, funded, or published. All authors agree that this justification at least requires a convincing argument that a study's design could yield scientifically valid results; some authors would additionally require the study to have a socially favorable risk‐benefit profile. (shrink)

With this book Paul Virilio inaugurated the new science whose object of study is the "dromocratic" revolution. Speed and Politics is the matrix of Virilio's entire work. Building on the works of Morand, Marinetti, and McLuhan, Virilio presents a vision more radically political than that of any of his French contemporaries: speed as the engine of destruction. Speed and Politics presents a topological account of the entire history of humanity, honing in on the technological advances made possible through the militarization (...) of society. Paralleling Heidegger's account of technology, Virilio's vision sees speed—not class or wealth—as the primary force shaping civilization. In this "technical vitalism," multiple projectiles—inert fortresses and bunkers, the "metabolic bodies" of soldiers, transport vessels, and now information and computer technology—are launched in a permanent assault on the world and on human nature. Written at a lightning-fast pace, Virilio's landmark book is a split-second, overwhelming look at how humanity's motivity has shaped the way we function today, and what might come of it. (shrink)

Allusions to the Panathenaia 1 in the final scene of the Eumenides have been pointed out by a number of scholars.2 Headlam identified the red robes of the Eumenides with the cloaks worn by the Metics in the Panathenaic procession.3 In Athena's pronouncement at 1030–1.

Peterson, Karlawish, and Largent’s “Supported Decision Making with People at the Margins of Autonomy” brings welcome attention to the rights of people with cognitive impairment and provides...

Rapid advancements in artificial intelligence and machine learning (AI/ML) in healthcare raise pressing questions about how much users should trust AI/ML systems, particularly for high stakes clinical decision-making. Ensuring that user trust is properly calibrated to a tool’s computational capacities and limitations has both practical and ethical implications, given that overtrust or undertrust can influence over-reliance or under-reliance on algorithmic tools, with significant implications for patient safety and health outcomes. It is, thus, important to better understand how variability in trust (...) criteria across stakeholders, settings, tools and use cases may influence approaches to using AI/ML tools in real settings. As part of a 5-year, multi-institutional Agency for Health Care Research and Quality-funded study, we identify trust criteria for a survival prediction algorithm intended to support clinical decision-making for left ventricular assist device therapy, using semistructured interviews (n=40) with patients and physicians, analysed via thematic analysis. Findings suggest that physicians and patients share similar empirical considerations for trust, which were primarilyepistemicin nature, focused on accuracy and validity of AI/ML estimates. Trust evaluations considered the nature, integrity and relevance of training data rather than the computational nature of algorithms themselves, suggesting a need to distinguish ‘source’ from ‘functional’ explainability. To a lesser extent, trust criteria were also relational (endorsement from others) and sometimes based on personal beliefs and experience. We discuss implications for promoting appropriate and responsible trust calibration for clinical decision-making use AI/ML. (shrink)

Hypocretin regulates brain reward function and cocaine consumption in rats. The hypocretinergic (Hcrt) system is implicated in energy homeostasis, feeding and sleep regulation. Hypocretinergic cell bodies are located in the lateral hypothalamus (LH) and project throughout the brain. The aim of the present studies was to investigate the role of the Hcrt system in regulating brain reward function and the reinforcing properties of cocaine in rats. Intracranial self-stimulation (ICSS) thresholds provide an accurate measure of brain reward function in rats. Here (...) we show that a single injection of Hcrt-1 (5 µg icv) induced persistent, long-lasting elevations in ICSS thresholds in drug-naïve rats. Indeed, Hrct-1 elevated ICSS thresholds for 36 h, with peak elevations between 6 and 12 hours after injection. Hrct-1-induced threshold elevations were attenuated by an antibody known to neutralize the binding of hcrt-1 to its receptors. Taken together, these observations suggest that Hrct-1 negatively regulates brain reward function in rats. Because Hrct-1 negatively regulates brain reward function, we hypothesized that it may attenuate the increased brain reward function usually observed after cocaine consumption, and thereby alter cocaine self-administration behavior. A daily injection of Hrct-1 (1 µg icv), for 4 consecutive days, slightly increased cocaine self-administration (0.25 mg/infusion) in rats. Overall, these data demonstrate that Hrct-1 negatively regulates brain reward function, and as such may indirectly alter cocaine self-administration. Given the well-established role of hypocretin neurons in regulating feeding behavior and sleep, we hypothesize that hypocretinergic regulation of brain reward function may provide a mechanism by which appropriate and competing behaviors (e.g. sleep or feeding) may be engaged to maintain energy homeostasis. (shrink)

Metacognition, the cognition about cognition, is closely linked to intelligence and therefore understanding the metacognitive processes underlying intelligence test performance, specifically on Raven’s Progressive Matrices, could help advance the knowledge about intelligence. The measurement of metacognition, is often done using domain-general offline questionnaires or domain-specific online think-aloud protocols. This study aimed to investigate the relationship between metacognitive awareness and intelligence via the design and use of a novel Meta-Cognitive Awareness Scale – Domain Specific that encourages reflection of task strategy processes. (...) This domain-specific scale was first constructed to measure participants’ awareness of their own metacognition linked to Raven’s Progressive Matrices. Following discriminatory index and Exploratory Factor Analysis, a 15-item scale was derived. Exploratory Factor Analysis showed five factors: Awareness of Engagement in Self-Monitoring, Awareness of Own Ability, Awareness of Responding Speed/Time, Awareness of Alternative Solutions and Awareness of Requisite Problem-Solving Resources. The intelligence level of ninety-eight adults was then estimated using Raven’s Standard Progressive Matrices. Participants also completed the MCAS-DS, and further items that examined their test-taking behavior and Confidence level. Metacognitive awareness was positively correlated to standardized IQ scores derived from the SPM whilst Over-Confidence derived using the Confidence level measure was negatively correlated to SPM. Despite some limitations, this study shows promise for elucidating the relationship between metacognitive awareness and intelligence using the task-specific scale. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

The fruits of knowledge—such as books, data, and ideas—tend to generate far more attention than the ways in which knowledge is produced and acquired. Correcting this imbalance, Making Knowledge in Early Modern Europe brings together a wide-ranging yet tightly integrated series of essays that explore how knowledge was obtained and demonstrated in Europe during an intellectually explosive four centuries, when standard methods of inquiry took shape across several fields of intellectual pursuit. Composed by scholars in disciplines ranging from the history (...) of science to art history to religious studies, the pieces collected here look at the production and consumption of knowledge as a social process within many different communities. They focus, in particular, on how the methods employed by scientists and intellectuals came to interact with the practices of craftspeople and practitioners to create new ways of knowing. Examining the role of texts, reading habits, painting methods, and countless other forms of knowledge making, this volume brilliantly illuminates the myriad ways these processes affected and were affected by the period’s monumental shifts in culture and learning. (shrink)

Screening for prostate cancer with the prostate-specific antigen blood test is controversial, as evidence to date has not demonstrated such screening does more good than harm. While the potential benefit of PSA screening on reducing prostate cancer mortality has not been documented in randomized trials, many risks of PSA screening have been well documented. These risks include a substantially higher risk of a prostate cancer diagnosis over a screenee’s lifetime, false-positive and false-negative test results, possible complications from biopsies done in (...) response to suspicious test results, and substantial risks of side effects from subsequent prostate cancer treatments. Nevertheless, PSA screening is widespread in the United States, and many physicians in a national survey reported supporting routine PSA screening as well as getting PSA tests themselves, despite the lack of evidence. (shrink)

We present a new road map for research on “How the Brain Got Language” that adopts an EvoDevoSocio perspective and highlights comparative neuroprimatology – the comparative study of brain, behavior and communication in extant monkeys and great apes – as providing a key grounding for hypotheses on the last common ancestor of humans and monkeys and chimpanzees and the processes which guided the evolution LCA-m → LCA-c → protohumans → H. sapiens. Such research constrains and is constrained by analysis of (...) the subsequent, primarily cultural, evolution of H. sapiens which yielded cultures involving the rich use of language. (shrink)

We face significant challenges in the translation of basic biomedical research into meaningful improvements in patients' health, moving research from “bench to bedside.” The federal government's ne...