Current health care standards, in many countries, Australia included, are regrettably poor. Surprisingly, practitioners and treating teams alike in mental health and disability sectors, in particular, make far too many basic care-related mistakes, in addition to the already abundant diagnostic mistakes that cause and amplify great harm. In part, too many practitioners also fail to distinguish adverse effects for what they are and all too often treat adverse effects, instead, as comorbidities. Diagnostic failures are dangerous, the result of (...) which generates and perpetuates harms that are extremely costly in terms of patient welfare, in addition to the financial burden placed on everyone. In this essay, I contend that the authority bestowed upon psychiatry is misplaced. Subsequently, this misplaced authority affects the governing and investigatory institutions reliant and informed by psychiatry. The examination process undertaken in this investigation traces the metaphysics of psychiatric disorders relative to the Diagnostic-Statistical-Manual (DSM) in all its iterations and to the epistemological construction process that serves to underpin the fundamentals of psychiatric practice. There exists a crisis of confidence in psychiatric practice and I urge drastic reform be undertaken to arrest the damage. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 11.4 (2004) 299-301 [Access article in PDF] The Right Not to Know: A Challenge for Accurate Self-Assessment Ruth F. Chadwick Anderson and Lux present a very interesting and thought-provoking argument for the view that accurate self-assessment is a requirement for personal autonomy. What I want to suggest is that although this may be helpful in the context with which these authors are primarily concerned, namely (...) psychiatry and brain dysfunction, it is of less value to an account of autonomy more widely construed. I want to look at a possible counterexample, taken from another area of medicine, namely genetics.Toward the end of their article Anderson and Lux consider three objections to their position. I shall not discuss them all. My concern is with the third, that inaccurate self-assessment sometimes promotes autonomy, because knowing the truth about one's weaknesses is sometimes very debilitating. It is commonly argued that "you can if you think you can" and vice versa. As they point out, there are some complex issues involved here, in that if the result of the positive thinking is the ability to do the thing in question, then how can the self-assessment be deemed to have been inaccurate in the first place? They go on, however, to say that "it is unclear that inflated self-assessments yield benefits in contexts where what is required is not just effort but competence" (290).Now it has been argued, by some, in the context of genetics, that the proper understanding of autonomy may imply a "right not to know" facts about oneself. In other words, this is not just a matter of accurate or inaccurate assessment of the relevant facts about oneself; rather, what may be involved is a deliberate decision not to have access to facts that may be relevant to that assessment. There are clearly cases in which genetic information appears to be pertinent to an accurate self-assessment, as the following example suggests. Suppose there is information "available", through genetic testing, that would affect one's chances of having children, or of having children without a particular genetic disorder, and, knowing that such information is available, a couple decides not to avail themselves of this. This is clearly an inaccurate self-assessment, but is their autonomy compromised?It might be thought that the reasons for this decision not to know could be relevant. If they have no family history of any particular genetic disorder, it could be regarded as subjectively reasonable to decline such testing as might be offered. Anderson and Lux, however, argue that whether or not a self-assessment is accurate depends on externalities. In other words, A's self-assessment is not to be assessed as accurate, or [End Page 299] not, according to what it is subjectively reasonable to believe; it has to be measured against the facts. The more that the possibilities of genetic testing increase, the more that "facts" of this nature will be available, including in the context of psychiatry.It might be objected that genetic information is not the type of information that is relevant in this context. In so far as it is predictive and probabilistic it is, arguably, different from the type of diagnostic information involved in the cases discussed by Anderson and Lux. It is not the place here, however, to discuss in general terms the thesis of "genetic exceptionalism" with regard to medical information. The important point is refusal of access to information that may be relevant to an accurate self-assessment. Historically, people have been mistaken in their self-assessment because of lack of information—for example, lack of understanding of facts about the reproduction process has led individuals automatically to blame the woman partner of a couple for infertility. And, as Anderson and Lux rightly point out, being autonomous is compatible with making mistakes, and indeed requires the freedom to make mistakes, it would look rather different if a person continued to hold this without any attempt to avail himself of the relevant—and now available—information... (shrink)

Counterfactual imaginings are known to have far reaching implications. In the present experiment, we ask if imagining events from one's past can affect memory for childhood events. We draw on the social psychology literature showing that imagining a future event increases the subjective likelihood that the event will occur. The concepts of cognitive availability and the source monitoring framework provide reasons to expect that imagination may inflate confidence that a childhood event occurred. However, people routinely produce myriad counterfactual imaginings (i.e., (...) daydreams and fantasies) but usually do not confuse them with past experiences. To determine the effects of imagining a childhood event, we pretested subjects on how confident they were that a number of childhood events had happened, asked them to imagine some of those events, and then gathered new confidence measures. For each of the target items, imagination inflated confidence that the event had occurred in childhood. We discuss implications for situations in which imagination is used as an aid in searching for presumably lost memories. (shrink)

Diagnostic frameworks are essential to many scientific and technological activities and clinical practice. This study examines the main fundamental aspects of such frameworks. The three components required for all diagnoses are identified and examined, i.e. their normative dimension, temporal nature and structure, and teleological perspective.The normative dimension of a diagnosis is based on (1) epistemic values when associated with Hempel's inductive risk concerning the balance between false‐positive and false‐negative outcomes, leading to probabilistic judgements; and (2) non‐epistemic values when related (...) to ideas such as well‐being, normality, illness, etc, as idealized norms or ideal points of reference.It should be noted that medical diagnoses match the three necessary components, while some essential diagnostic frameworks – the taxonomies ofGordon andNANDA– in nursing lack some components. The main lack is normative as the most popular frameworks in nursing diagnosis seem to be descriptions of observed reality rather than normative and value‐based judgements in which both epistemic and non‐epistemic values may coexist. (shrink)

Cosmological inflation is widely considered an integral and empirically successful component of contemporary cosmology. It was originally motivated by its solution of certain so-called fine-tuning problems of the hot big bang model, particularly what are known as the horizon problem and the flatness problem. Although the physics behind these problems is clear enough, the nature of the problems depends on the sense in which the hot big bang model is fine-tuned and how the alleged fine-tuning is problematic. Without clear (...) explications of these, it remains unclear precisely what problems inflationary theory is meant to be solving and whether it does in fact solve them. I analyze the structure of these problems and consider various interpretations that may substantiate the alleged fine-tuning. On the basis of this analysis I argue that at present there is no unproblematic interpretation available for which it can be said that inflation solves the big bang model’s alleged fine-tuning problems. (shrink)

In eternally inflating cosmology, infinitely many pocket universes are seeded. Attempts to show that universes like our observable universe are probable amongst them have failed, since no unique probability measure is recoverable. This lack of definite probabilities is taken to reveal a complete predictive failure. Inductive inference over the pocket universes, it would seem, is impossible. I argue that this conclusion of impossibility mistakes the nature of the problem. It confuses the case in which no inductive inference is possible, with (...) another in which a weaker inductive logic applies. The alternative, applicable inductive logic is determined by background conditions and is the same, non-probabilistic logic as applies to an infinite lottery. This inductive logic does not preclude all predictions, but does affirm that predictions useful to deciding for or against eternal inflation are precluded. (shrink)

This paper explores how the diagnosis of mental disorder may affect the diagnosed subject’s self-concept by supplying an account that emphasizes the influence of autobiographical and social narratives on self-understanding. It focuses primarily on the diagnoses made according to the criteria provided by the Diagnostic Statistical Manual of Mental Disorders (DSM), and suggests that the DSM diagnosis may function as a source of narrative that affects the subject’s self-concept. Engaging in this analysis by appealing to autobiographies and memoirs written (...) by people diagnosed with mental disorder, the paper concludes that a DSM diagnosis is a double-edged sword for self- concept. On the one hand, it sets the subject’s experience in an established classificatory system which can facilitate self-understanding by providing insight into subject’s condition and guiding her personal growth, as well as treatment and recovery. In this sense, the DSM diagnosis may have positive repercussions on self-development. On the other hand, however, given the DSM’s symptom-based approach and its adoption of the Biomedical Disease model, a diagnosis may force the subject to make sense of her condition divorced from other elements in her life that may be affecting her mental- health. It may lead her frame her experience only as an irreversible imbalance. This form of self-understanding may set limits on the subject’s hopes of recovery and may create impediments to her flourishing. (shrink)

Counterfactual imaginings are known to have far reaching implications. In the present experiment, we ask if imagining events from one's past can affect memory for childhood events. We draw on the social psychology literature showing that imagining a future event increases the subjective likelihood that the event will occur. The concepts of cognitive availability and the source monitoring framework provide reasons to expect that imagination may inflate confidence that a childhood event occurred. However, people routinely produce myriad counterfactual imaginings (i.e., (...) daydreams and fantasies) but usually do not confuse them with past experiences. To determine the effects of imagining a childhood event, we pretested subjects on how confident they were that a number of childhood events had happened, asked them to imagine some of those events, and then gathered new confidence measures. For each of the target items, imagination inflated confidence that the event had occurred in childhood. We discuss implications for situations in which imagination is used as an aid in searching for presumably lost memories. (shrink)

The 'Phillips curve' represents the inverse relationship between inflation & unemployment, & is a central concept in macroeconomic analysis. This volume offers an assessment of how more sophisticated analysis of prices & wage setting & inflation expectations have changed the nature of the curve.

In their article on the limited duty to reinterpret genetic variants, Watts and Newson argue that clinical labs are not morally obligated to conduct routine reinterpretation despite its potential clinical and personal value.1 We endorse the authors’ argument for a circumscribed duty to reclassify genomic variants in certain cases, including to promote diagnostic equity for racial and ethnic minority populations that have been historically excluded from and exploited by genomic research and medicine. However, given the history and resilience of (...) scientific racism, the use of socially constructed racial and ethnic categories to enhance diagnostic equity raises several ethical and practical challenges. In the short term, using socially constructed racial and ethnic categories to identify patients for variant reclassification is a practical approach for addressing concerns of diagnostic equity. In contrast, diagnostic accuracy depends on patients’ genetic similarity to reference genomes, rather than their socially determined race or ethnicity.2 Thus, in the long term, securing both diagnostic equity and diagnostic accuracy through targeted variant reclassification will require a shift away from relying on race and ethnicity and towards assessing genetic similarity. Critically, the identification of patients for genomic variant reclassification using socially constructed race or ethnicity runs the risk of perpetuating the harmful …. (shrink)

Guth provided a persuasive rationale for inflationary cosmology based on its ability to solve fine-tuning problems of big bang cosmology. Yet one of the most important consequences of inflation was only widely recognized a few years later: inflation provides a mechanism for generating small departures from uniformity, needed to seed formation of subsequent structures, by “freezing out” vacuum fluctuations to form classical density perturbations. This paper recounts the historical development of this aspect of inflation and puts it (...) in context of the development of ideas on structure formation in relativistic cosmology, before turning to the comparison between inflation and a competing account of structure formation based on topological defects. One aim is to assess in what sense inflation is empirically tested through its account of the formation of structure, in light of persistent debates among cosmologists regarding whether inflation is “falsifiable.”. (shrink)

My aim in this paper is to show how the problem of inflated effect sizes corrupts the severity measure of evidence. This has never been done. In fact, the Winner’s Curse is barely mentioned in the philosophical literature. Since the severity score is the predominant measure of evidence for frequentist tests in the philosophical literature, it is important to underscore its flaws. It is also crucial to bring the philosophical literature up to speed with the limits of classical testing. The (...) Winner’s Curse is one of them. The problem is that when a significant result is obtained by using an underpowered test, the severity score becomes particularly high for large discrepancies from the null-hypothesis. This means that such discrepancies are very well supported by the evidence according to that measure. However, it is now well documented that significant tests with low power display inflated effect sizes. They systematically show departures from the null hypothesis H0 that are much greater than they really are. From an epistemological point of view this means that a significant result produced by an underpowered test does not provide evidence for large discrepancies from H0. Therefore, the severity score is an inadequate measure of evidence. Given that we are now aware of the phenomenon of inflated effect sizes, it would be irresponsible to rely on the severity score to measure the strength of the evidence against the null. Instead, one must take appropriate measures to try and avoid using underpowered tests by setting a threshold for the sample size or by replicating the results of the experiment. (shrink)

I consider a quantum system that possesses key features of quantum shape dynamics and show that the evolution of wave-packets will become increasingly classical at late times and tend to evolve more and more like an expanding classical system. At early times however, semiclassical effects become large and lead to an exponential mismatch of the apparent scale as compared to the expected classical evolution of the scale degree of freedom. This quantum inflation of an emergent and effectively classical system, (...) occurs naturally in the quantum shape dynamics description of the system, while it is unclear whether and how it might arise in a constrained Hamiltonian quantization. (shrink)

Some have thought that the process of the expansion of the universe can be used to define an absolute ‘cosmic time’ which then serves as the absolute time required by tensed theories of time. Indeed, this is the very reason why many tense theorists are happy to concede that special relativity is incompatible with the tense thesis, because they think that general relativity, which trumps special relativity, and on which modern cosmology rests, supplies the means of defining temporal becoming using (...) cosmic time. I argue that cosmic time is not up to the task, and that these tense theorists should rethink their strategy in dealing with the theories of relativity. Introduction The Mellor-Rees argument against tense theories Can expansion combat such wrinkles? Event and creation horizons Bursting the balloon. (shrink)

This chapter focuses on one of the common fallacies in Western philosophy called the inflation of conflict (IC). A form of IC is a type of hasty generalization. A wider view of how things stand outside the courtroom may reveal little real disagreement among experts. Conventions in the popular press that promote “both sides of the story” or constant debate formats seem to encourage this type of IC. Another form of IC correctly points to disagreement in a field but (...) incorrectly implies that, as a result, little can be known. Noting disagreement among authorities can be the basis of a good argument. When there is widespread disagreement on the core aspects of a topic and the participants are bona fide authorities, then there is a good reason for a non‐expert to suspend judgment on the issue. (shrink)

I address the objection that the concept of racism has become overly inflated. Critics of the conceptual inflation of “racism” argue that theories of institutional racism engage in untoward conceptual inflation insofar as they undermine our moral understanding of racial phenomena, hinder our ability to explain the causes of racial inequality, and even undercut struggles for racial justice. I develop an original account of institutional racism and show that it is immune to all three versions of the conceptual (...) inflation challenge. (shrink)

Using the twelve-year animal cycle, this paper uncovers and examines the dual phenomena of “age inflation” and “age deflation” in medieval China. While the first part raises serious doubt on the accuracy of the conventional method for calculating birth year in premodern China, the second section examining the deflation phenomenon provides yet another proof of the omnipotent law of economic rationality.

Relative price stability is central to the security of valued forms of life in contemporary liberal democracies, and disruptions to price stability can be and have been understood and experienced as emergencies. However, while the relation between price and emergency can be understood in juridico–political terms, this article argues for the importance of attending to the affective dimensions of this relation. This argument is developed through a discussion of the affective life of price in relation to the disruptive event of (...) inflation, an event characterized by an atmosphere of emergency that takes place as a disturbance of the rhythms and relations of which everyday life consists. Haunted by the spectre of this emergency, governing price in liberal democracies needs to be understood not only through regulatory measures designed to act directly upon price, but also in terms of efforts to act upon the affective spacetimes from which price-emergencies can emerge. (shrink)

In the framework of a cosmological model of the Universe filled with a nonrelativistic particle soup, we easily reproduce inflation due to the quantum potential. The lightest particles in the soup serve as a driving force of this simple, natural and promising mechanism. It is explicitly demonstrated that the appropriate choice of their mass and fraction leads to reasonable numbers of e-folds. Thus, the direct introduction of the quantum potential into cosmology of the earliest Universe gives ample opportunities of (...) successful reconsideration of the modern inflationary theory. (shrink)

In 1958, economist A. W. Phillips published an article describing what he observed to be the inverse relationship between inflation and unemployment; subsequently, the "Phillips curve" became a central concept in macroeconomic analysis and policymaking. But today's Phillips curve is not the same as the original one from fifty years ago; the economy, our understanding of price setting behavior, the determinants of inflation, and the role of monetary policy have evolved significantly since then. In this book, some of (...) the top economists working today reexamine the theoretical and empirical validity of the Phillips curve in its more recent specifications. The contributors consider such questions as what economists have learned about price and wage setting and inflation expectations that would improve the way we use and formulate the Phillips curve, what the Phillips curve approach can teach us about inflation dynamics, and how these lessons can be applied to improving the conduct of monetary policy. ContributorsLawrence Ball, Ben Bernanke, Oliver Blanchard, V. V. Chari, William T. Dickens, Stanley Fischer, Jeff Fuhrer, Jordi Gali, Michael T. Kiley, Robert G. King, Donald L. Kohn, Yolanda K. Kodrzycki, Jane Sneddon Little, Bartisz Mackowiak, N. Gregory Mankiw, Virgiliu Midrigan, Giovanni P. Olivei, Athanasios Orphanides, Adrian R. Pagan, Christopher A. Pissarides, Lucrezia Reichlin, Paul A. Samuelson, Christopher A. Sims, Frank R. Smets, Robert M. Solow, Jürgen Stark, James H. Stock, Lars E. O. Svensson, John B. Taylor, Mark W. Watson. (shrink)

This article argues for an anti-deflationist view of scientific representation. Our discussion begins with an analysis of the recent Callender–Cohen deflationary view on scientific representation. We then argue that there are at least two radically different ways in which a thing can be represented: one is purely symbolic, and therefore conventional, and the other is epistemic. The failure to recognize that scientific models are epistemic vehicles rather than symbolic ones has led to the mistaken view that whatever distinguishes scientific models (...) from other representational vehicles must merely be a matter of pragmatics. It is then argued that even though epistemic vehicles also contain conventional elements, they do their job of demonstration in spite of such elements. (shrink)

In most areas of medicine, the physician's primary task is to diagnose the patient's presenting problem by correctly identifying the underlying pathology causing that problem. Diagnoses are established through a process of correlating the information obtained from an interview with the patient about his history of illness and circumstances, with additional evidence of the underlying disease derived from physical examination findings and/or the results of laboratory investigations and diagnostic imaging. In contemporary health care, various movements that call for a (...) shift in clinical care away from underlying disease pathology toward understanding people and their experience of disease are receiving growing... (shrink)

Human illusions and the Biblical call to hope.

Diagnostic testing can be used for many purposes, including testing to facilitate the clinical care of individual patients, testing as an inclusion criterion for clinical trial participation, and both passive and active surveillance testing of the general population in order to facilitate public health outcomes, such as the containment or mitigation of an infectious disease. As such, diagnostic testing presents us with ethical questions that are, in part, already addressed in the literature on clinical care as well as (...) clinical research (such as the rights of patients to refuse testing or treatment in the clinical setting or the rights of participants in randomized controlled trials to withdraw from the trial at any time). However, diagnostic testing, for the purpose of disease surveillance also raises ethical issues that we do not encounter in these settings, and thus have not been much discussed. In this paper we will be concerned with the similarities and differences between the ethical considerations in these three domains: clinical care, clinical research, and public health, as they relate to diagnostic testing specifically. Via an examination of the COVID-19 case we will show how an appeal to the concept of diagnostic justice helps us to make sense of the (at times competing) ethical considerations in these three domains. (shrink)

The aim of the article is to show how the use of diagnostic methods allows identifying patterns and problems of corporations functioning, providing identification of directions and strategies for further development of their business. Theoretical and methodological basis of the research is a scientific works of scientists in the field of business diagnostics and strategic development, who studied diagnostics in the system of responding to business development problems, identifying areas for improving strategic management, financial statements of corporations of Daimler (...) Group (Germany), Tesla Motors (USA) and Toyota Motor (Japan) and own research results. The methodological basis of the study is a set of general and special methods used to achieve the goal of the research and includes: theoretical generalization and synthesis – in analyzing the content of scientific works on business diagnostics and strategic management; observation – to obtain primary information about the state of business of automotive companies in the world; indicator and integrated assessment – to assess the state of business and the effectiveness of strategic management of automotive corporations; information and logical analysis – when determining the issues and patterns of business development of corporations; problem-target method – to justify the choice of business development strategies; causation-result method – to obtain definitive conclusions. The results of the study of the state of business of the world's leading automotive corporations revealed the dependence of business efficiency on the degree of efficiency of strategic management of their activities, and identified types of strategies that will promote further development of automotive corporations – integrated, concentrated, diversified or globalized growth. The practical significance of the obtained results lies in their usefulness for strategic management for Daimler Group, Tesla Motors, Toyota Motor Corporation. (shrink)

Cet ouvrage est une réédition numérique d’un livre paru au XXe siècle, désormais indisponible dans son format d’origine.

A new diagnostic modeling system for automatically synthesizing a deep‐structure model of a student's misconceptions or bugs in his basic mathematical skills provides a mechanism for explaining why a student is making a mistake as opposed to simply identifying the mistake. This report is divided into four sections: The first provides examples of the problems that must be handled by a diagnostic model. It then introduces procedural networks as a general framework for representing the knowledge underlying a skill. (...) The challenge in designing this representation is to find one that facilitates the discovery of misconceptions or bugs existing in a particular student's encoding of this knowledge. The second section discusses some of the pedagogical issues that have emerged from the use of diagnostic models within an instructional system. This discussion is framed in the context of a computer‐based tutoring/gaming system developed to teach students and student teachers how to diagnose bugs strategically as well as how to provide a better understanding of the underlying structure of arithmetic skills. The third section describes our uses of an executable network as a tool for automatically diagnosing student behavior, for automatically generating “diagnostic” tests, and for judging the diagnostic quality of a given exam. Included in this section is a discussion of the success of this system in diagnosing 1300 school students from a data base of 20.000 test items. The last section discusses future research directions. (shrink)

Inspired by Ronald Giere’s cognitive approach to scientific models, Cognitive Structural Realism has presented a naturalist account of scientific representation. CSR characterises the structure of theories in terms of cognitive structures. These are informational structures embodied in the brains of scientists. CSR accounts for scientific representation in terms of the dynamical relationship between the organism and its environment. The proposal has been criticised on account of its negligence of social aspects of scientific practice. The present paper aims to chart out (...) a reply to the objection. It shows that cognitive structures do not need to be put inside the brains of single individuals. Cognitive structures are redefined as extended structures in distributed cognitive systems under Free Energy Principle. (shrink)

In recent decades, we have seen a remarkable proliferation of the kinds of moral rights that people are thought to have. While many of these new rights have gained sizable support, the theoretical underpinnings of all rights have remained uncertain. The danger in the growth of rights claims is that we may weaken rights. As more and more desirable goods are demanded as people's "rights," the actual protection which rights afford is diminished. Abundant rights will bump up against one another, (...) preventing many rights from being fully satisfied. The long-term effect of this rights inflation will be the erosion of the value of rights, rather than the intended aim of enhanced security for people. ;The dissertation examines in two stages what the status of rights should be. First, it explores the history of the notion of rights, the exact meaning of what it is to have a right, and the obligations which rights place on other persons. It also presents an argument defending the view that all people have certain moral rights "naturally," independently of social creation or recognition. ;The second stage of the discussion focusses more directly on certain aspects of the recent expansion of rights claims. It delineates the logical and practical implications of rights "conflicts" which the boom in rights precipitates. Finally, it considers one particular type of rights which has been enjoying increasing acceptance: rights to be provided with concrete goods . ;The major conclusions reached are first, that the notion of "natural" moral rights is a credible and valuable component within an adequate moral theory; second, that individuals do have extensive rights to freedom of action; third, that "natural" moral rights cannot directly conflict with one another; and fourth, that welfare rights are spurious. ;As a whole, this work is intended largely as a caution to tame the recent enthusiasm for rights. Restraint is needed in order to preserve rights, and to allow rights to exert their protective powers to individuals more effectively. (shrink)

Aims: The Research Diagnostic Criteria for Temporomandi¬bular Disorders (RDC/TMD) Axis I diagnostic algorithms were demonstrated to be reliable but below target sensitivity and specificity. Empirical data supported Axis I algorithm revisions that were valid. Axis II instruments were shown to be both reliable and valid. An international consensus workshop was convened to obtain recommendations and finalization of new Axis I diagnostic algorithms and new Axis II instruments. Methods: A comprehensive search of published TMD diagnostic literature was (...) followed by review and consensus via a formal structured process by a panel of experts for revision of the RDC/TMD. Results: The recommended Diagnostic Criteria for TMD (DC/TMD) Axis I protocol includes both a valid screener for pain diagnoses and valid criteria for the most common pain-related TMDs and for one intra-articular disorder. The Axis II protocol retains selected RDC/TMD screening instruments augmented with new instruments to better assess the interactions between pain and psychosocial functioning. A comprehensive classification system is also presented. Conclusion: The recommended evidence-based DC/TMD protocol is appropriate for use in both the clinical and research settings. Simple Axis I and II screening tests augmented by validated Axis I and Axis II instruments allow for identification of simple to complex TMD patients. (shrink)

Diagnosing the Diagnostic and Statistical Manual of Mental Disorders (Karnac, 2014) evaluates the latest edition of the D.S.M.The publication of D.S.M-5 in 2013 brought many changes. Diagnosing the Diagnostic and Statistical Manual of Mental Disorders asks whether the D.S.M.-5 classifies the right people in the right way. It is aimed at patients, mental health professionals, and academics with an interest in mental health. Issues addressed include: How is the D.S.M. affected by financial links with the pharmaceutical industry? To (...) what extent were and should patients involved in revising the classification? How are diagnoses added to the D.S.M.? Does medicalization threaten the idea that anyone is normal? What happens when changes to diagnostic criteria mean that people lose their diagnoses? How important will the D.S.M. be in the future? (shrink)

ObjectiveThis study aimed to develop a diagnostic model of multi-kinematic parameters for patients with amnestic mild cognitive impairment (aMCI).MethodIn this cross-sectional study, 94 older adults were included (33 cognitively normal, CN; and 61 aMCI). We conducted neuropsychological battery tests, such as global cognition and cognitive domains, and collected gait parameters by an inertial-sensor gait analysis system. Multivariable regression models were used to identify the potential diagnostic variables for aMCI. Receiver operating characteristic (ROC) curves were applied to assess the (...) diagnostic accuracy of kinematic parameters in discriminating aMCI from healthy subjects.ResultsMultivariable regression showed that multi-kinematic parameters were the potential diagnostic variables for aMCI. The multi-kinematic parameter model, developed using Timed Up and Go (TUG) time, stride length, toe-off/heel stride angles, one-leg standing (OLS) time, and braking force, showed areas under ROC (AUC), 0.96 [95% confidence interval (CI), 0.905–0.857]; sensitivity, 0.90; and specificity, 0.91. In contrast, a single kinematic parameter’s sensitivity was 0.26–0.95 and specificity was 0.21–0.90. Notably, the separating capacity of multi-kinematic parameters was highly similar to Montreal Cognitive Assessment (MoCA; AUC: 0.96 vs. 0.95). Compared to cognitive domain tests, the separating ability was comparable to Auditory Verbal Learning Test (AVLT) and Boston Naming Test (BNT; AUC: 0.96 vs. 0.97; AUC: 0.96 vs. 0.94).ConclusionWe developed one diagnostic model of multi-kinematic parameters for patients with aMCI in Foshan. (shrink)

Within child and adolescent psychiatry, there are a number of potential dilemmas pertaining to diagnosis, treatment, the protection of the child, as well as the child's own developing intelligence and moral judgement. Diagnostic Dilemmas in Child and Adolescent Psychiatry is the first in the IPPP series to explore this highly complex topic.

The complexity of cognitive emulation of human diagnostic reasoning is the major challenge in the implementation of computer-based programs for diagnostic advice in medicine. We here present an epistemological model of diagnosis with the ultimate goal of defining a high-level language for cognitive and computational primitives. The diagnostic task proceeds through three different phases: hypotheses generation, hypotheses testing and hypotheses closure. Hypotheses generation has the inferential form of abduction (from findings to hypotheses) constrained under the criterion of (...) plausibility. Hypotheses testing is achieved by a deductive inference (from generated hypotheses to expected findings), followed by an eliminative induction, constrained under the criterion of covering, which matches expected findings against patient''s findings to select the best explanation. Hypotheses closure is a deductive-inductive type of inference very similar to the inferences operating in hypotheses testing. In this case induction matches the consequences of the generated hypotheses against the patient''s characteristics or preferences under the criterion of utility. By using the language exploited in this epistemological model, it is possible to describe the cognitive tasks underlying the most influential knowledge-based diagnostic systems. (shrink)

Background Most studies on medical reasoning focus on contemporary allopathic practitioners. Here, the significance of diagnostic sense in Nizāmī ‘Arūzī’s Four Discourses (Chahār Maqāle), an influential text that circulated widely throughout the Islamic world, is explored. Methods After a brief introduction, key passages are translated on how doctors should cultivate analytical skills. Results Nizāmī ‘Arūzī cites three sources of diagnostic authority: (1) education in the texts of medical experts, (2) formal logic and (3) belief in the power of (...) God. Conclusions ‘Arūzī’s methods, though rooted in a religious faith that may seem foreign to contemporary doctors and educators, has much to recommend regarding its clarity of approach, its high ethical standards and expectations of doctors, and its commitment to best practices for the patient. Crosscultural studies of medical education and professionalism can offer valuable insights by demonstrating how doctors across history and geography have grappled with the common concerns of diagnosis and treatment. (shrink)

The past hypothesis is that the entropy of the universe was very low in the distant past. It is put forward to explain the entropic arrow of time but it has been suggested. The emperor’s new mind. London:Vintage Books; Penrose, R.. Annals of the New York Academy of Sciences, 571, 249–264; Price, H.. In S. F. Savitt, Times’s arrows today. Cambridge: Cambridge University Press; Price, H.. Time’s arrow and Archimedes’ point. Oxford: Oxford University Press; Price, H.. In C. Hitchcock, Contemporary (...) debates in philosophy of science. Oxford: Blackwell]) that it is itself in need of explanation. It has also been suggested that cosmic inflation could provide the explanation, but Price raises a serious objection to this suggestion, which has otherwise received very little attention in the philosophical literature. Price points out that the standard inflationary explanation involves a double standard: although the evolution of the universe described by the inflationary model seems natural from the standard temporal perspective it looks highly unnatural from the reversed temporal perspective. The main purpose of this paper is to propose a novel form of the inflationary explanation that avoids this objection. It is argued that the inflationary model would not involve a double standard if we construct the model with a global “boundary” condition instead of a conventional boundary condition: if we assume that the universe is as generic as possible overall, rather than as generic as possible at some given point as is assumed in the standard inflationary model. This novel form of the inflationary explanation is then compared with Price’s 1996 preferred explanation, a version of the so-called “Weyl hypothesis”. (shrink)

Diagnostic self-testing devices are being developed for many illnesses, chronic diseases and infections. These will be used in hospitals, at point-of-care facilities and at home. Designed to allow earlier detection of diseases, self-testing diagnostic devices may improve disease prevention, slow the progression of disease and facilitate better treatment outcomes. These devices have the potential to benefit both the individual and society by enabling individuals to take a more proactive role in the maintenance of their health and by helping (...) society improve health and reduce health costs. However, the full implications of future home-based diagnostic technology for individuals and society remain unclear due to their novelty. We argue that the development of diagnostic tools, especially for home use, will heighten a number of ethical challenges. This paper will explore some of the ethical implications of home-based self-testing diagnostic devices for the autonomous and relational dimensions of the person. This will be facilitated by examining the impact of diagnostic devices for individual autonomy, for the delivery of accurate diagnosis and for the personal significance of the information for the user. The latter will be examined using Charles Taylor's view of personhood and his emphasis on human agency and interpretation. While the ethical issues are not necessarily new, the development of home-based self-testing diagnostic devices will make issues regarding autonomy, accuracy of information and personal significance more and more demanding. This will be the case particularly when an individual's autonomous choices come into conflict with the person's relational responsibilities. (shrink)

Experimental philosophy’s much-discussed ‘restrictionist’ program seeks to delineate the extent to which philosophers may legitimately rely on intuitions about possible cases. The present paper shows that this program can be (i) put to the service of diagnostic problem-resolution (in the wake of J.L. Austin) and (ii) pursued by constructing and experimentally testing psycholinguistic explanations of intuitions which expose their lack of evidentiary value: The paper develops a psycholinguistic explanation of paradoxical intuitions that are prompted by verbal case-descriptions, and presents (...) two experiments that support the explanation. This debunking explanation helps resolve philosophical paradoxes about perception (known as ‘arguments from hallucination’). (shrink)

The causal compatibility question asks whether a given causal structure graph — possibly involving latent variables — constitutes a genuinely plausible causal explanation for a given probability distribution over the graph’s observed categorical variables. Algorithms predicated on merely necessary constraints for causal compatibility typically suffer from false negatives, i.e. they admit incompatible distributions as apparently compatible with the given graph. In 10.1515/jci-2017-0020, one of us introduced the inflation technique for formulating useful relaxations of the causal compatibility problem in terms (...) of linear programming. In this work, we develop a formal hierarchy of such causal compatibility relaxations. We prove that inflation is asymptotically tight, i.e., that the hierarchy converges to a zero-error test for causal compatibility. In this sense, the inflation technique fulfills a longstanding desideratum in the field of causal inference. We quantify the rate of convergence by showing that any distribution which passes the nth-order inflation test must be On−1/2$\begin{array}{} \displaystyle {O}{\left(n^{{{-}{1}}/{2}}\right)} \end{array}$-close in Euclidean norm to some distribution genuinely compatible with the given causal structure. Furthermore, we show that for many causal structures, the (unrelaxed) causal compatibility problem is faithfully formulated already by either the first or second order inflation test. (shrink)

Diagnostic errors are more frequently a result of the clinician's failure to combine medical knowledge adequately than of data inaccuracy. Diagnostic reasoning studies are valuable to understand and improve diagnostic reasoning. However, most diagnostic reasoning studies are characterized by some limitations which make these studies seem more simple than diagnostic reasoning in real life situations actually is. These limitations are connected both to the failure to acknowledge components of knowledge used in clinical practice as well (...) as to acknowledge the physician-patient relationship's influence on clinical knowledge and on the reasoning process itself. In addition the modes of reasoning described in these studies frequently is oversimplified. In this paper three simplistic and competing models of diagnostic reasoning are analyzed and criticized, followed by an evaluation of two alternative models proposing a combined view. (shrink)