There is a need to consider the impact of the new resident-hours regulations on the variety of aspects of medical education and patient care. Most existing literature about this subject has focused on the role of fatigue in resident performance, education, and health care delivery. However, there are other possible consequences of these new regulations, including a negative impact on decision ownership. Our main assumption of is that increased shift work in medicine can decrease ownership of treatment decisions and impact (...) negatively on quality of care. We review some potential components of decision ownership in treatment context and suggest possible ways in which the absence of decision ownership may decrease the quality of medical decision making. The article opens with the definition of decision ownership and the overview of some contextual factors that may contribute to the development of ownership in medical residency. The following section discusses decision ownership in medical care from the perspe... (shrink)

We citizens of the 21st century live in a world where division of epistemic labour rules. Most of what we know we learned from the spoken or written word of others, and we depend in endless practical ways on the technological fruits of the dispersed knowledge of others—of which we often know almost nothing—in virtually every moment of our lives. Interest has been growing in recent years amongst philosophers, in the issues in epistemology raised by this fact. One issue concerns (...) the depth and extent of our epistemic dependence on testimony, as we may label this broad epistemic source: Do we have any knowledge at all that is free of epistemic dependence on what we have learned from others? A related question is whether our entitlement to believe what we have learned from others can be explained without invoking any epistemic principles special to testimony. These questions concern, as it were, the macro-epistemology of testimony. In the present discussion I shall focus instead on the micro foundations. Testimony, in our broad sense, can occur through an extensive range of types of spoken and written means of purportedly factual communication, including telephone calls, e-mails and personal letters, lectures and radio broadcasts, newspapers, textbooks and encyclopaedias, personal diaries, and public records of all kinds. But the central paradigm—what started the whole communication thing off—is surely that of face-to-face spoken encounter, when one person tells something to another, thereby intending and hoping to share her knowledge with her audience. I begin by describing the speech act of telling, identifying what takes place in a felicitous act of telling. From the nature of the speech act of telling, we see precisely how it is that knowledge is, when all goes as it should, acquired from teller by trusting hearer, in such an act, and in acts of testimony more broadly. (shrink)

The inhuman in the humanities : Darwin and the ends of man -- Deleuze, Bergson, and the concept of life -- Bergson, Deleuze, and difference -- Feminism, materialism, and freedom -- The future of feminist theory : dreams for new knowledges -- Differences disturbing identity : Deleuze and feminism -- Irigaray and the ontology of sexual difference -- Darwin and the split between natural and sexual selection -- Sexual difference as sexual selection : Irigarayan reflections on Darwin -- Art and (...) the animal -- Living art and the art of life : women's painting from the western desert. (shrink)

Although debates continue, studies of cognition in infancy suggest that knowledge begins to emerge early in life and constitutes part of humans' innate endowment. Early-developing knowledge appears to be both domain-specific and task-specific, it appears to capture fundamental constraints on ecologically important classes of entities in the child's environment, and it appears to remain central to the commonsense knowledge systems of adults.

We citizens of the 21st century live in a world where division of epistemic labour rules. Most of what we know we learned from the spoken or written word of others, and we depend in endless practical ways on the technological fruits of the dispersed knowledge of others—of which we often know almost nothing—in virtually every moment of our lives. Interest has been growing in recent years amongst philosophers, in the issues in epistemology raised by this fact. One issue concerns (...) the depth and extent of our epistemic dependence on testimony, as we may label this broad epistemic source: Do we have any knowledge at all that is free of epistemic dependence on what we have learned from others? A related question is whether our entitlement to believe what we have learned from others can be explained without invoking any epistemic principles special to testimony. These questions concern, as it were, the macro-epistemology of testimony. In the present discussion I shall focus instead on the micro foundations. Testimony, in our broad sense, can occur through an extensive range of types of spoken and written means of purportedly factual communication, including telephone calls, e-mails and personal letters, lectures and radio broadcasts, newspapers, textbooks and encyclopaedias, personal diaries, and public records of all kinds. But the central paradigm—what started the whole communication thing off—is surely that of face-to-face spoken encounter, when one person tells something to another, thereby intending and hoping to share her knowledge with her audience. I begin by describing the speech act of telling, identifying what takes place in a felicitous act of telling. From the nature of the speech act of telling, we see precisely how it is that knowledge is, when all goes as it should, acquired from teller by trusting hearer, in such an act, and in acts of testimony more broadly. (shrink)

This new and important study of semantic change examines how new meanings arise through language use, especially the various ways in which speakers and writers experiment with uses of words and constructions in the flow of strategic interaction with addressees. In the last few decades there has been growing interest in exploring systemicities in semantic change from a number of perspectives including theories of metaphor, pragmatic inferencing, and grammaticalization. Like earlier studies, these have for the most part been based on (...) data taken out of context. This book is the first detailed examination of semantic change from the perspective of historical pragmatics and discourse analysis. Drawing on extensive corpus data from over a thousand years of English and Japanese textual history, Traugott and Dasher show that most changes in meaning originate in and are motivated by the associative flow of speech and conceptual metonymy. (shrink)

Testimony is indispensable in the sciences. To deny the propriety of relying on it engenders an untenable scepticism. But this leaves open the issue of what exactly confers a scientist’s epistemic right to rely upon the word of her colleagues. Some authors have suggested a recipient of testimony enjoys an epistemic entitlement to trust the word of another as such, not requiring evidence of her trustworthiness, so long as there is not evidence of her untrustworthiness. I argue that, whether or (...) not such an on-no-evidence entitlement to believe what one is told exists, it shrinks to irrelevance in the explanation of the basis on which scientists take each other’s word in the scientific community. This is so, since a normally knowledgeable adult hearer is typically awash with relevant evidence, direct and circumstantial, for and against, concerning a teller’s trustworthiness, and this swamps any alleged entitlement to believe in the absence of such evidence. There need not be personal knowledge of the teller, since social role and topic provide evidence regarding trustworthiness. I also discuss the individuation of ‘testimony’ as an epistemic kind. I suggest that we should not attempt to define a category with sharp boundaries, but instead characterise a paradigm case—one person telling another something in face-to-face personal communication—and then notice other cases which both resemble and diverge from this in epistemically relevant features—lectures, media broadcasts, personal letters, personal diaries, etc.Author Keywords: Testimony; Justification; Knowledge; Individualism; Communication. (shrink)

One of the central points of contention in the epistemology of testimony concerns the uniqueness (or not) of the justification of beliefs formed through testimony-whether such justification can be accounted for in terms of, or 'reduced to,' other familiar sort of justification, e.g. without relying on any epistemic principles unique to testimony. One influential argument for the reductionist position, found in the work of Elizabeth Fricker, argues by appeal to the need for the hearer to monitor the testimony for (...) credibility. Fricker (1994) argues, first, that some monitoring for trustworthiness is required if the hearer is to avoid being gullible, and second, that reductionism but not anti-reductionism is compatible with ascribing an important role to the process of monitoring in the course of justifiably accepting observed testimony. In this paper we argue that such an argument fails. (shrink)

This book explores the tradition of the 'science of man' in French medicine of the era 1750-1850, focusing on controversies about the nature of the 'physical-moral' relation and their effects on the role of medicine in French society. Its chief purpose is to recover the history of a holistic tradition in French medicine that has been neglected because it lay outside the mainstream themes of modern medicine, which include experimental, reductionist, and localistic conceptions of health and disease. Professor Williams also (...) challenges existing historiography, which argues that the 'anthropological' approach to medicine was a short-term by-product of the leftist politics of the French Revolution. This work argues instead that the medical science of man long outlived the Revolution, that it spanned traditional ideological divisions, and that it reflected the shared aim of French physicians, whatever their politics, to claim broad cultural authority in French society. (shrink)

In his article ‘Saints and Heroes’, Urmson argues that traditional moral theories allow at most for a threefold classification of actions in terms of their worth, and that they are therefore unsatisfactory. Since the conclusion of his argument has led to the widespread use of the term ‘acts of supererogation’, and since I do not believe that such acts exist, I propose to argue that the actions with which he is concerned not only can, but should, be contained within the (...) traditional classification. (shrink)

Process models are valuable conceptual tools to help in understanding the approaches to value creation in social enterprises. This teaching case illustrates the application of a process model about creating, building, and sustaining a social enterprise with a mission to provide clean water to communities in need. The social enterprise generates revenue in support of community water projects and works with community stakeholders in different locations throughout the world to provide sustainable clean water solutions. The case study uses primary data (...) from semi-structured interviews, direct observations of a community project, and archival sources to demonstrate application of the process model. The study shows how the social enterprise developed as a promising idea; was implemented through an operating model with resources to support social impact; and continues to build and evolve while guided by the social mission. The paper concludes with a discussion and teaching note on ways to use the case for educational purposes to enhance learning about the social value creation process. (shrink)

BackgroundUse of routinely collected patient data for research and service planning is an explicit policy of the UK National Health Service and UK government. Much clinical information is recorded in free-text letters, reports and notes. These text data are generally lost to research, due to the increased privacy risk compared with structured data. We conducted a citizens’ jury which asked members of the public whether their medical free-text data should be shared for research for public benefit, to inform an ethical (...) policy.MethodsEighteen citizens took part over 3 days. Jurors heard a range of expert presentations as well as arguments for and against sharing free text, and then questioned presenters and deliberated together. They answered a questionnaire on whether and how free text should be shared for research, gave reasons for and against sharing and suggestions for alleviating their concerns.ResultsJurors were in favour of sharing medical data and agreed this would benefit health research, but were more cautious about sharing free-text than structured data. They preferred processing of free text where a computer extracted information at scale. Their concerns were lack of transparency in uses of data, and privacy risks. They suggested keeping patients informed about uses of their data, and giving clear pathways to opt out of data sharing.ConclusionsInformed citizens suggested a transparent culture of research for the public benefit, and continuous improvement of technology to protect patient privacy, to mitigate their concerns regarding privacy risks of using patient text data. (shrink)

There is an emerging ethical consensus that injured research participants should receive medical care and compensation for their research-related injuries. This consensus is premised on notions of beneficence, distributive justice, compensatory justice and reciprocity. In response, countries around the world have implemented no-fault compensation systems to ensure that research participants are adequately protected in the event of injury. The United States, the world's leading sponsor of research, has chosen instead to rely on its legal system to provide injured research participants (...) with medical care and compensation. This article argues that US reliance on its legal system leaves injured research participants unprotected in the event of injury. Nearly every injured research participant will have difficulty receiving compensation in court, and certain classes of research participants will be barred from receiving compensation altogether. The United States’ outlier status also threatens to impede US-sponsored multinational research, potentially delaying important biomedical advances. To rectify this injustice, researchers, Institutional Review Boards, sponsors and research institutions should advocate systematic no-fault compensation in the United States to bring US law into accord with global ethical norms and ensure that injured research participants are adequately protected. (shrink)

Book synopsis: The feminist movement has challenged many of the unstated assumptions on which ethics as a branch of philosophy has always rested - assumptions about human nature, moral agency, citizenship and kinship. The twenty-six readings in this book express the discontent of a succession of fiercely articulate women writers, from Mary Wollstonecraft to the present day, with the masculine bias of `morality'. The editors have contributed an overall introduction, which discusses ethics, feminism and feminist themes in ethics, and have (...) provided introductions to each of the readings, designed to situate in their historical and intellectual context. They have also compiled two lists for further reading: `Ethics: a Feminist Bibliography' and `The Male Tradition'. Ethics: A Feminist Reader is an essential resource for students and teachers of philosophy, political theory and women's studies. For anyone with a stake in progressive sexual politics it is an inspirational guide. (shrink)

How does talk work, and can we engage the public in a dialogue about the scientific study of talk? This article presents a history, critical evaluation and empirical illustration of the public science of talk. We chart the public ethos of conversation analysis that treats talk as an inherently public phenomenon and its transcribed recordings as public data. We examine the inherent contradictions that conversation analysis is simultaneously obscure yet highly cited; it studies an object that people understand intuitively, yet (...) routinely produces counter-intuitive findings about talk. We describe a novel methodology for engaging the public in a science exhibition event and show how our ‘conversational rollercoaster’ used live recording, transcription and public-led analysis to address the challenge of demonstrating how talk can become an informative object of scientific research. We conclude by encouraging researchers not only to engage in a public dialogue but also to find ways to actively engage people in taking a scientific approach to talk as a pervasive, structural feature of their everyday lives. (shrink)

Five-year-old children categorized as skilled versus unskilled counters were given verbal estimation and number word comprehension tasks with numerosities 20 – 120. Skilled counters showed a linear relation between number words and nonsymbolic numerosities. Unskilled counters showed the same linear relation for smaller numbers to which they could count, but not for larger number words. Further tasks indicated that unskilled counters failed even to correctly order large number words differing by a 2 : 1 ratio, whereas they performed well on (...) this task with smaller numbers, and performed well on a nonsymbolic ordering task with the same numerosities. These findings provide evidence that large, approximate numerosity representations become linked to number words around the time that children learn to count to those words reliably. (shrink)

In recent years, historians of science have increasingly turned their attention to the “print culture” of early modern science. These studies have revealed that printing, as both a technology and a social and economic system, structured the forms and meanings of natural knowledge. Yet in early modern Europe, naturalists, including John Aubrey, John Evelyn, and John Ray, whose work is discussed in this paper, often shared and read scientific texts in manuscript either before or in lieu of printing. Scribal exchange, (...) exemplified in the circulation of writings like commonplace books, marginalia, manuscript treatises, and correspondence, was the primary means by which communities of naturalists constructed scientific knowledge. Print and manuscript were necessary partners. Manuscript fostered close collaboration, and could be circulated relatively cheaply; but, unlike print, it could not reliably secure priority or survival for posterity. Naturalists approached scribal and print communication strategically, choosing the medium that best suited their goals at any given moment. As a result, print and scribal modes of disseminating information, constructing natural knowledge, and organizing communities developed in tandem. Practices typically associated with print culture manifested themselves in scribal texts and exchanges, and vice versa. “Print culture” cannot be hived off from “scribal culture.” Rather, in their daily jottings and exchanges, naturalists inhabited, and produced, one common culture of communication. (shrink)

This article provides a broad survey of issues facing rural communities and suggests that medicalization of poverty concepts and interventions need to be tailored to those populations. Rural poverty may be both broader and deeper than in urban areas. Those challenges seem to produce a constellation of health conditions, as rural residents struggle with unemployment and lack of opportunities. Relatedly, rural communities struggle to maintain financially viable hospitals and specialty providers. The article closes by offering a snapshot of rural-specific strategies (...) to address these issues. (shrink)

Some philosophers have argued that so long as two neural events, within a subject, are both of the same type and both carry the same content, then these events may jointly constitute a single mental token, regardless of the sort of causal relation to each other that they bear. These philosophers have used this claim—which I call the “singularity-through-redundancy” position—in order to argue that a split-brain subject normally has a single stream of consciousness, disjunctively realized across the two hemispheres. This (...) paper argues, against this position, that the kind of causal relations multiple neural events bear to each other constrains the mental tokens with which functionalists who are realists can identify them. (shrink)

This comprehensive and up-to-date textbook gives a clear account of the different philosophical and theoretical approaches to psychology and discusses major philosophical questions such as free will and the relation between mind and body.

In the present paper, we first argue that it is critical for humans to forget; that is, to have some means of preventing out-of-date information from interfering with the recall of current information. We then argue that the primary means of accomplishing such adaptive updating of human memory is retrieval inhibition: Information that is rendered out of date by new learning becomes less retrievable, but remains at essentially full strength in memory as indexed by other measures, such as recognition and (...) word-fragment completion. We conclude with a speculation that certain unconscious influences of prior events may, in fact, be stronger if those events were to be forgotten rather than to be remembered. (shrink)

Feminist strong substantive autonomy (FSSA), as presented by Natalie Stoljar and Anita Superson, pronounces judgment on the autonomy status of certain women living under oppression. These women act on deformed desires, Superson explains, and as deformed desires cannot be the agent's own, the women are heteronomous. Stoljar argues that some women's choices violate the Feminist Intuition; by acting on false and oppressive values, these women render themselves heteronomous. I argue against Stoljar and Superson on epistemological grounds. I present six different (...) ways in which agents' choices can be related to deformed desires, with varying results for their autonomy statuses. I show that Stoljar and Superson are not able to distinguish properly among the differing autonomy statuses in these six cases, because doing so requires attention to agents' inner processes of decision-making, as those processes are enacted in the agents' social and temporal contexts. Stoljar and Superson judge others' autonomy statuses based on abstract generalizations rather than via empirical attention to agents' actual decision-making processes. Consequently, their judgments are not adequate to the lived self-direction of real persons. Assessing others' autonomy status requires consideration of agents' inner choice-making in sociotemporal context, which favors a procedural or weak substantive account of autonomy. (shrink)

We consider the version of Pure Inductive Logic which obtains for the language with equality and a single unary function symbol giving a complete characterization of the probability functions on this language which satisfy Constant Exchangeability.

The broad objective of this paper is to examine the evolution of gendered aspects of livelihood strategies and their interaction with various development interventions. Central to this is an empirical analysis of gendered divisions of labor in the context of rapidly changing pastoralist livelihoods. The paper begins with a literature review on gender roles in pastoralist societies. Two important gaps in the existing literature are identified. First, studies on gender roles are too often studies on women’s roles as men’s roles (...) are rarely included. Secondly, despite a recognition that pastoral livelihoods are rapidly changing, much of the research has ignored the gendered impacts of this change. The study area is Loitokitok Division, Kajiado District, Kenya. Field data were collected in an extensive household survey, key informant interviews, and group discussions held in two field seasons between 2001 and 2004. Results indicate that development interventions led to land use encapsulation, sedentarization, new ways of accessing dry season grazing areas, new land uses, new livestock breeds, and increased school enrollment. In the context of these livelihood changes and increasing drought, a fundamental shift in gendered roles in livestock production has occurred. Maasai women in the study area contribute more labor to livestock production than men do. Various efforts to modernize the livestock sector are leading to a loss of women’s control of milk resources. This finding has important implications for current and future development interventions in pastoralist communities and their ability to improve livelihoods of the most vulnerable sections of the population. (shrink)