In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

AimThe neurocognitive basis of Developmental Coordination Disorder remains an issue of continued debate. This combined systematic review and meta-analysis provides a synthesis of recent experimental studies on the motor control, cognitive, and neural underpinnings of DCD.MethodsThe review included all published work conducted since September 2016 and up to April 2021. One-hundred papers with a DCD-Control comparison were included, with 1,374 effect sizes entered into a multi-level meta-analysis.ResultsThe most profound deficits were shown in: voluntary gaze control during movement; cognitive-motor integration; practice-/context-dependent (...) motor learning; internal modeling; more variable movement kinematics/kinetics; larger safety margins when locomoting, and atypical neural structure and function across sensori-motor and prefrontal regions.InterpretationTaken together, these results on DCD suggest fundamental deficits in visual-motor mapping and cognitive-motor integration, and abnormal maturation of motor networks, but also areas of pragmatic compensation for motor control deficits. Implications for current theory, future research, and evidence-based practice are discussed.Systematic Review RegistrationPROSPERO, identifier: CRD42020185444. (shrink)

This paper explores a trans-Atlantic clash about time: in 1899, American philosopher Mary Calkins argued we should not spatialize time; in 1899, British philosopher Victoria Welby argued we should. I take their disagreement as a starting point to contextualize, study, and compare the accounts of time presented in their respective articles. Both Calkins and Welby cared deeply about time, writing on the topic across their careers, but their views have not been studied by historians of philosophy. This is unfortunate, for (...) I argue their novel theories reward attention. Calkins’ 1899 account draws on Kant to arrive at the earliest American-British causal theory of time, pioneers the metaphysical applications of temporal experimental psychology, and replies to F. H. Bradley’s proclamation that it is ‘impossible’ to explain the appearance of time. Meanwhile, I read Welby’s 1907 account as offering a radical metaphysic, on which time is literally a kind of space, resonating with 1880s literature around the ‘fourth dimension’ and H. G. Wells’ 1895 novel The Time Machine. I have uncovered an early draft of Welby’s paper dating to 1902 and, using this alongside other unstudied writings by Welby, trace the development of her views from the 1880s onwards. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

This paper compares the views of Kant and F.H. Bradley on the nature of judgment or experience. We argue that, while there are many differences between their idealist systems, Kant and Bradley agree on a basic issue: there is a sense in which a whole judgment or experience is prior to its parts. Through the extended metaphor of cake baking, we show that for Kant there is an important sense in which a judgment --in spite of resulting from the synthesis (...) of a manifold --is prior to its parts; and, for Bradley, immediate experience is prior to the very notion of parts. Kant and Bradley disagree over the nature of the idealist cake, but they agree that the cake is prior to its slices. (shrink)

The study of human behavior is severely hampered by logistical problems, ethical and legal constraints, and funding shortfalls. However, the biggest difficulty of conducting social and behavioral research is the extraordinary complexity of the study phenomena. In this article, we review the impact of complexity on research design, hypothesis testing, measurement, data analyses, reproducibility, and the communication of findings in psychological science. The systematic investigation of the world often requires different approaches because of the variability in complexity. Confirmatory testing, multi-factorial (...) designs, survey methods, large samples, and modeling are frequently needed to study complex social and behavioral topics. Complexity impedes the measurement of general constructs, the reproducibility of results and scientific reporting, and the general rigor of research. Many of the benchmarks established by classic work in physical science are not attainable in studies of more complex phenomena. Consequently, the standards used to evaluate scientific research should be tethered to the complexity of the study topic. (shrink)

Postnatal/postpartum depression had a pre-COVID-19 estimated prevalence ranging up to 23% in Europe, 33% in Australia, and 64% in America, and is detrimental to both mothers and their infants. Low social support is a key risk factor for developing PND. From an evolutionary perspective this is perhaps unsurprising, as humans evolved as cooperative childrearers, inherently reliant on social support to raise children. The coronavirus pandemic has created a situation in which support from social networks beyond the nuclear family is likely (...) to be even more important to new mothers, as it poses risks and stresses for mothers to contend with; whilst at the same time, social distancing measures designed to limit transmission create unprecedented alterations to their access to such support. Using data from 162 mothers living in London with infants aged ≤6 months, we explore how communication with members of a mother’s social network related to her experience of postnatal depressive symptoms during the first “lockdown” in England. Levels of depressive symptoms, as assessed via the Edinburgh Postnatal Depression Scale, were high, with 47.5% of the participants meeting a ≥11 cut-off for PND. Quasi-Poisson regression modelling found that the number of network members seen in-person, and remote communication with a higher proportion of those not seen, was negatively associated with depressive symptoms; however, contact with a higher proportion of relatives was positively associated with symptoms, suggesting kin risked seeing mothers in need. Thematic qualitative analysis of open text responses found that mothers experienced a burden of constant mothering, inadequacy of virtual contact, and sadness and worries about lost social opportunities, while support from partners facilitated family bonding. While Western childrearing norms focus on intensive parenting, and fathers are key caregivers, our results highlight that it still “takes a village” to raise children in high-income populations and mothers are struggling in its absence. (shrink)

Alloparenting, wherein people provide care to children who are not their biological offspring, is a key aspect of human child-rearing. In the Pacific, many children are adopted or fostered by custodial alloparents even when both biological parents are still alive. From a behavioral ecology perspective, such behaviors are puzzling: why parent someone else’s child at your expense? Furthermore, little is known about how these arrangements are made in Pacific Islander societies today, who provides care, and what kinds of outcomes fostered (...) children experience. A better understanding of these proximate factors may help reveal the ultimate drivers behind custodial alloparenting. Here, we report findings from a survey carried out with the caregivers of 282 children in rural areas of Vanuatu, an island nation in Melanesia. Most fostered and adopted children lived with relatives such as aunts, uncles, and grandparents (87.5%) rather than unrelated caregivers, with a strong preference for maternal kin. The most common reasons for these arrangements were that the parents had separated (16.7%), were engaging in labor migration (27.1%), or a combination of both (27.1%). Results for investment in children’s education and their educational outcomes were mixed, although children removed from crisis situations did more poorly than children removed for aspirational reasons. Our findings suggest that custodial alloparenting helps families adapt to socioeconomic transitions and changing marriage practices. Outcomes may depend on a range of factors, such as the reason children were transferred out of the natal home to begin with. (shrink)

Emily Dickinson is the most paradoxical of poets: the very poet of paradox. By way of voluminous biographical material, not to mention the extraordinary intimacy of her poetry, it would seem that we know everything about her; yet the common experience of reading her work, particularly if the poems are read sequentially, is that we come away seeming to know nothing. We could recognize her inimitable voice anywhere—in the “prose” of her letters no less than in her poetry—yet it (...) is a voice of the most deliberate, the most teasing anonymity. “I’m Nobody!” is a proclamation to be interpreted in the most literal of ways. Like no other poet before her and like very few after her—Rilke comes most readily to mind, and, perhaps, Yeats and Lawrence—Dickinson exposes her heart’s most subtle secrets; she confesses the very sentiments that, in society, would have embarrassed her dog . Yet who is this “I” at the center of experience? In her astonishing body of 1,775 poems Dickinson records what is surely one of the most meticulous examinations of the phenomenon of human “consciousness” ever undertaken. The poet’s persona—the tantalizing “I”—seems, in nearly every poem, to be addressing us directly with perceptions that are ours as well as hers. The poems’ refusal to be rhetorical, their daunting intimacy, suggests the self-evident in the way that certain Zen koans and riddles do while being indecipherable. But what is challenged is, perhaps, “meaning” itself: Wonder—is not precisely KnowingAnd not precisely Knowing not—A beautiful but bleak conditionHe has not lived who has not felt—Suspense—is his maturer Sister—Whether Adult Delight is PainOr of itself a new misgiving—This is the Gnat that mangles men— [1331, ca. 1874]1 1. The Complete Poems of Emily Dickinson, ed. Thomas H. Johnson ; subsequent references in the text to the poems will cite the Johnson number and the date assigned by Johnson to each poem. Joyce Carol Oates is the Roger S. Berlind Distinguished Lecturer at Princeton University and the author most recently of the booklength essay On Boxing. “Soul at the White Heat” will be included in her book of essays, Writer: Occasions and Opportunities, to be published in the spring of 1988. (shrink)

Biomarkers can be powerful tools to guide diagnosis, treatment, and research. However, prudent use of biomarkers requires formal validation efforts. Although the data needed for biomarker validation has traditionally been hard to access, new research initiatives can ease this process.

The FDA's new table of surrogate endpoints used for drug approvals is an important step forward for overseeing the use of biomarkers in clinical trials. Nevertheless, we present several ways in which the table can be improved.

Person‐specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self‐determination method with people with various long‐term health conditions. It explains the mechanisms of mobilizing relational capacity by including person‐specific evidence in shared decision‐making. Person‐specific self‐insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self‐management challenges. This step paved the way for sharing these insights and (...) challenges in a relationship with a supportive health professional, who could then rely on person‐specific evidence instead of assumptions or a narrow disease perspective for shared decision‐making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person‐specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self‐insights in daily life with other people, decreasing loneliness they experienced in self‐management. Relational capacity, the core of the theory, is mobilized in both people with long‐term health conditions and healthcare professionals. Further research on person‐specific evidence and relational capacity in healthcare is recommended. (shrink)

For Emily Dickinson, writing often meant experimenting. She experimented with words so as to acquire new perspectives through her representations of the self and the world. It certainly looks as if each one of her most intense poems was an attempt to see how far one could go both with language and consciousness, and she accordingly knew that the general public would find her experiments unreadable. Only since 1955, when Thomas H. Johnson published the first collected edition, have (...) we slowly become aware of their own internal logic. Dickinson must be placed and understood in the context of other artistic experimenters such as Friedrich Hölderlin, Arthur Rimbaud, Paul Cézanne, and Antonin Artaud, as well as... (shrink)

Abstract“Suffering” is a central concept within bioethics and often a crucial consideration in medical decision making. As used in practice, however, the concept risks being uninformative, ambiguous, or even misleading. In this paper, we consider a series of cases in which “suffering” is invoked and analyze them in light of prominent theories of suffering. We then outline ethical hazards that arise as a result of imprecise usage of the concept and offer practical recommendations for avoiding them. Appeals to suffering are (...) often getting at something ethically important. But this is where the work of ethics begins, not where it ends. (shrink)

What is time? This is one of the most fundamental questions we can ask. Emily Thomas explores how a new theory of time emerged in the seventeenth century. The 'absolute' theory of time held that it is independent of material bodies or human minds, so even if nothing else existed there would be time.

There are doubtless many with personal experience of suffering, or of comforting others in distress, who would agree with Milton thus far that philosophic argument is powerless to satisfy those who in their anguish ask the question ‘Why did it happen to me?’ Yet to think so is to underestimate both the necessity and the power of reason: clarity of mind and the disposition to argue are commonly enhanced rather than diminished by suffering; and if reason is an essential part (...) of man's nature, it should serve him, if anywhere, in the trials of life. We have every justification, therefore, despite common opinion, for seeking a rational answer to the question proposed. It must, however, be admitted at the outset that there is no direct answer to the question which can both withstand critical scrutiny and bring genuine comfort to the afflicted, an answer, that is, which accepts the question as it stands with its attendant presuppositions; but there is an indirect answer, which, precisely by rejecting one or more of these presuppositions and restating the question, can indeed satisfy these two requirements. Before such an answer can be outlined, however, the question in its traditional form must be examined and the traditional answers to it critically reviewed. (shrink)

Human microbiome research makes causal connections between entire microbial communities and a wide array of traits that range from physiological diseases to psychological states. To evaluate these causal claims, we first examine a well-known single-microbe causal explanation: of Helicobacter pylori causing ulcers. This apparently straightforward causal explanation is not so simple, however. It does not achieve a key explanatory standard in microbiology, of Koch’s postulates, which rely on manipulations of single-microorganism cultures to infer causal relationships to disease. When Koch’s postulates (...) are framed by an interventionist causal framework, it is clearer what the H. pylori explanation achieves and where its explanatory strengths lie. After assessing this ‘simple’, single-microbe case, we apply the interventionist framework to two key areas of microbiome research, in which obesity and mental health states are purportedly explained by microbiomes. Despite the experimental data available, interventionist criteria for explanation show that many of the causal claims generated by microbiome research are weak or misleading. We focus on the stability, specificity and proportionality of proposed microbiome causal explanations, and evaluate how effectively these dimensions of causal explanation are achieved in some promising avenues of research. We suggest some conceptual and explanatory strategies to improve how causal claims about microbiomes are made. (shrink)

Human microbiome research makes causal connections between entire microbial communities and a wide array of traits that range from physiological diseases to psychological states. To evaluate these causal claims, we first examine a well-known single-microbe causal explanation: of Helicobacter pylori causing ulcers. This apparently straightforward causal explanation is not so simple, however. It does not achieve a key explanatory standard in microbiology, of Koch’s postulates, which rely on manipulations of single-microorganism cultures to infer causal relationships to disease. When Koch’s postulates (...) are framed by an interventionist causal framework, it is clearer what the H. pylori explanation achieves and where its explanatory strengths lie. After assessing this ‘simple’, single-microbe case, we apply the interventionist framework to two key areas of microbiome research, in which obesity and mental health states are purportedly explained by microbiomes. Despite the experimental data available, interventionist criteria for explanation show that many of the causal claims generated by microbiome research are weak or misleading. We focus on the stability, specificity and proportionality of proposed microbiome causal explanations, and evaluate how effectively these dimensions of causal explanation are achieved in some promising avenues of research. We suggest some conceptual and explanatory strategies to improve how causal claims about microbiomes are made. (shrink)

We report on the small-scale (0.5 13 h - 1M, a large-scale bias of ~2.0 and a satellite fraction of 12 ± 2 per cent. Thus, these galaxies occupy haloes with average masses in between those of the higher redshift BOSS CMASS sample and the original SDSS I/II luminous red galaxy sample © 2012 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society © doi:10.1093/mnras/sts314.

Issues of reliability are claiming center-stage in the epistemology of machine learning. This paper unifies different branches in the literature and points to promising research directions, whilst also providing an accessible introduction to key concepts in statistics and machine learning – as far as they are concerned with reliability.

For early modern metaphysician Anne Conway, the world comprises creatures. In some sense, Conway is a monist about creatures: all creatures are one. Yet, as Jessica Gordon-Roth has astutely pointed out, that monism can be understood in very different ways. One might read Conway as an ‘existence pluralist’: creatures are all composed of the same type of substance, but many substances exist. Alternatively, one might read Conway as an ‘existence monist’: there is only one created substance. Gordon-Roth has done the (...) scholarship a great favor by illuminating these issues in Conway. However, this article takes issue with Gordon-Roth's further view that Conway ‘oscillates’ between the extremes of existence pluralism and monism. In its place, I argue we should read Conway as a priority monist: the whole of creation is ontologically prior to its parts. (shrink)

The growing block view of time holds that the past and present are real whilst the future is unreal; as future events become present and real, they are added on to the growing block of reality. Surprisingly, given the recent interest in this view, there is very little literature on its origins. This paper explores those origins, and advances two theses. First, I show that although C. D. Broad’s Scientific Thought provides the first defence of the growing block theory, the (...) theory receives its first articulation in Samuel Alexander’s Space, Time, and Deity. Further, Alexander’s account of deity inclines towards the growing block view. Second, I argue that Broad shifted towards the growing block theory as a result of his newfound conviction that time has a direction. By way of tying these theses together, I argue that Broad’s views on the direction of time – and possibly even his growing block theory – are sourced in Alexander. (shrink)

Super-substantivalism is the thesis that space is identical to matter; it is currently under discussion ? see Sklar (1977, 221?4), Earman (1989, 115?6) and Schaffer (2009) ? in contemporary philosophy of physics and metaphysics. Given this current interest, it is worth investigating the thesis in the history of philosophy. This paper examines the super-substantivalism of Samuel Alexander, an early twentieth century metaphysician primarily associated with (the movement now known as) British Emergentism. Alexander argues that spacetime is ontologically fundamental and it (...) gives rise to an ontological hierarchy of emergence, involving novel properties such as matter, life and mind. Alexander's super-substantivalism is interesting not just because of its historical importance but also because Alexander unusually attempts to explain why spacetime is identical to matter. This paper carefully unpacks that explanation and shows how Alexander is best read as conceiving of spacetime as a Spinozistic substance, worked upon by evolution. (shrink)

For centuries, philosophers of time have produced texts containing words and pictures. Although some historians study visual representations of time, I have not found any history of philosophy on pictures of time within texts. This paper argues that studying such pictures can be rewarding. I will make this case by studying pictures of time in the works of Leibniz, Arthur Eddington and C. D. Broad, and argue they play subtle roles. Further, I will argue that historians of philosophy more widely (...) could benefit from paying more attention to pictures. (shrink)

Many scholars have drawn attention to the way that elements of Anne Conway’s system anticipate ideas found in Leibniz. This paper explores the relationship between Conway and Leibniz’s work with regard to time, space, and process. It argues – against existing scholarship – that Conway is not a proto-Leibnizian relationist about time or space, and in fact her views lie much closer to those of Henry More; yet Conway and Leibniz agree on the primacy of process. This exploration advances our (...) understanding of Conway’s system, and the intellectual relationships between Conway, More, and Leibniz. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

Abstract:Vulnerability is an important criterion to assess the ethical justification of the inclusion of participants in research trials. Currently, vulnerability is often understood as an attribute inherent to a participant by nature of a diagnosed condition. Accordingly, a common ethical concern relates to the participant’s decisionmaking capacity and ability to provide free and informed consent. We propose an expanded view of vulnerability that moves beyond a focus on consent and the intrinsic attributes of participants. We offer specific suggestions for how (...) relational aspects and the dynamic features of vulnerability could be more fully captured in current discussions and research practices. (shrink)