Malebranche's Theodicy ANDREW G. BLACK LEIBNIZ'S SOLUTION tO the problem of evil, his theodicy, might be regarded as a paradigm of philosophical theology. Its pattern, as with so much of Leibniz's philosophy, is reconciliation of deep metaphysical truth with recalcitrant ap- pearance. Thus, a theodicy is not just any solution to the problem; strictly speaking it is a vindication of divine providence in the face of the challenge posed by apparent imperfections of all kinds in creation.' The preeminence of (...) Leibniz's theodicy as a modern solution to the problem of evil has helped to obscure distinguished contributions from among his contemporaries. Not least among these is that made by Nicolas Malebranche, a philosopher having much in common with Leibniz . ~ Malebranche shows a deep concern for the problem of evil throughout his philosophical writings, though nowhere more so than in his Treatise on Nature and Grace, a a book written in response to the Jansenist4 challenge to orthodox In addition to an entire and substantial book, the Theodicy , a number of Leibniz's essays contain versions of his theodicy. See, for example, articles 1- 7 of the Discourse on Metaphysics; also "A Vindication of God's Justice Reconciled with his.. (shrink)

ObjectiveHead and neck cancer treatments are known to significantly affect functionality and appearance, leading to an increased risk for body image disturbances. Yet, few longitudinal studies exist to examine body image in these patients. Based on a conceptual model, the current study aimed to determine, in patients newly diagnosed with HNC: the prevalence, level, and course of body image concerns; correlates of upon cancer diagnosis body image concerns; predictors of immediate post-treatment body image concerns; and association between body image concerns (...) and levels of anxiety, depression, suicidal ideation, support, and alcohol and drug misuse.MethodsTwo hundred and twenty-three, newly diagnosed with a primary HNC were assessed using structured clinical interviews and psychometric measures at three, and 6 months after diagnosis. Primary outcome was 3-month, as it was most salient to body image disturbance. Multiple linear regression analyses were conducted on the potential body image predictors, based on the model.ResultsSixty-eight percent of patients with HNC presented some level of body image concerns. Body image concerns at baseline and post-treatment were significantly related and significantly increased from pre- to post-treatment. Immediately post-treatment, 89% presented some level of body image concerns. Correlates of body image concerns in patients with HNC at baseline included: physical symptom burden, difficulties with communication and eating, coping with the cancer diagnosis using denial, suicidal ideation, and having had a past anxiety diagnosis. When controlling for sociodemographic and medical variables, body image concerns in patients with HNC in the immediate post-treatment were predicted by: baseline body image, physical symptom burden, and neuroticism.ConclusionThis longitudinal study helps identify patients more susceptible to experience body image disturbance following head and neck cancer. Clinicians ought to pay special attention to body image concerns upon cancer diagnosis, physical symptom burden, and neuroticism, and may want to target these factors in future preventive interventions. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Objective: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. Study Design and Setting: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. Results: We find that concerns regarding explainability are (...) not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating unexplainable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. Conclusion: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems. (shrink)

Research now provides participants greater indications of genetic risk for disease, even for conditions incidental to the research study. Given this development, should such information also be disclosed to the family of research participants? There has been some indication at the national level that genetic risk information can be disclosed to participants' families; however, limited attention has been given to returning research results to family. Thus, we have also incorporated the discussion surrounding the disclosure of genetic risk discovered in the (...) clinic (e.g., genetic testing). A number of important questions are examined: Should genetic research results be provided to family? Are there differences between clinical and research findings that would prevent research results from being disclosed to family? Who should make the disclosure, if in fact it is done at all? We conclude by noting that the return of results is increasingly accepted as technology permits the discovery of more and more medically useful data. However, debates of whether results should be returned to participants must first be settled before moving to familial disclosure. (shrink)

The structure of the thermal equilibrium state of a weakly interacting Bose gas is of current interest. We calculate the density matrix of that state in two ways. The most effective method, in terms of yielding a simple, explicit answer, is to construct a generating function within the traditional framework of quantum statistical mechanics. The alternative method, arguably more interesting, is to construct the thermal state as a vector state in an artificial system with twice as many degrees of freedom. (...) It is well known that this construction has an actual physical realization in the quantum thermodynamics of black holes, where the added degrees of freedom correspond to the second sheet of the Kruskal manifold and the thermal vector state is a state of the Unruh or the Hartle–Hawking type. What is unusual about the present work is that the Bogolubov transformation used to construct the thermal state combines in a rather symmetrical way with Bogolubov's original transformation of the same form, used to implement the interaction of the nonideal gas in linear approximation. In addition to providing a density matrix, the method makes it possible to calculate efficiently certain expectation values directly in terms of the thermal vector state of the doubled system. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino (...) and Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

This article is written by a descendant of enslaved Africans and explores the theological significance of Black bodies. Black bodies have been commodified, controlled and coerced by White hegemony, often lacking agency and self-determination. Using personal experience and contextual analysis, this article, drawing on Black theology inspired reflections, argues that we need to rethink how we conceive of Black bodies ethically, if Black lives are to really matter. The rehabilitation of Black bodies is achieved (...) through a theological reappraisal of holiness and sacraments, underpinned by an embodied pneumatology, in which Black bodies are shown to be sacramental and worthy of mattering in a world underpinned by White supremacy. (shrink)

The advent of IVF and advances in reproductive technologies largely reflect the importance in our society of biological parenthood and genetic kinship. As illustrated in the controversy piece by Merle Spriggs,1 however, the same technology has confused our understanding of what makes a parent.An embryo mixup in Britain has resulted in a white couple giving birth to two black twins. Genetic tests have established that the wrong sperm was used to inseminate the ova of the white woman who gave (...) birth to the twins. The two couples involved are apparently both seeking custody. Who should have parental rights and responsibilities for the twins?While once it may have been obvious who a child’s parents were and who had obligations and claims with regard to children, the separation of genetic, gestational, and nurturing roles now makes it impossible to “discover” who is the real parent. As Ruth Macklin points out, the question: “Which role should entitle a woman to a greater claim on the baby in the case of a dispute?” is a moral question which cannot be answered by discovery, say through a blood test, but is a matter for decision.2 Which are the morally …. (shrink)

This article speaks to existential challenges facing Black people, predominantly of Caribbean descent, to live in what continues to be a White dominated and White entitled society. Working against the backdrop of the ‘Black Lives Matter’ movement that originated in the United States, this article analyses the socio-political and cultural frameworks that affirm Whiteness whilst concomitantly, denigrating Blackness. The author, a well-known Black liberation theologian, who is a child of the Windrush Generation, argues that Western Mission Christianity (...) has always exemplified a deep-seated form of anti-Blackness that has helped to shape the agency of Black bodies, essentially marking them as ‘less than’. This theological base has created the frameworks that have dictated the sematic belief that Black bodies do not really matter and if they do, then they are invariably second-class ones when compared to White bodies. In the final part of the article, the author outlines the ways in which Black theology in Britain, drawing on postcolonial theological and biblical optics, has sought to critique the ethnocentrism of White Christianity in Britain in order to assert that ‘Black Lives Do Matter’. (shrink)

In many regions around the world, those at highest risk for acquiring HIV are young adults and adolescents. Young men who have sex with men in the USA are the group at greatest risk for HIV acquisition, particularly if they are part of a racial or ethnic minority group.1 Adolescent girls and young women have the highest incidence rates of any demographic subgroup in sub-Saharan Africa.2 To reverse the global AIDS pandemic’s toll on these high-risk groups, it is important to (...) deploy the most effective HIV prevention tools to young MSM in the USA, to adolescent girls and young women in sub-Saharan Africa, and to any other adolescents and young adults at high risk for HIV as products are proven to be safe and efficacious. Although prevention interventions with proven efficacy, such as oral pre-exposure prophylaxis, are available,3–8 they have not been sufficient to stem the tide and an expanded prevention toolkit is urgently needed to serve these populations. The field of HIV prevention continues to identify promising leads in the development of new biomedical prevention products, either delivering antiviral drug topically or systemically. The dapivirine ring has been shown to provide modest protection and is currently being tested in open label studies while injectable cabotegravir is being tested in a large efficacy trial for preventing HIV acquisition. Advances in the field of HIV prevention mean that scientists and regulators must plan for how they will bring prevention tools to populations at high risk for HIV as they conduct efficacy and effectiveness trials. For instance, safety data from younger age groups can also be used in combination with efficacy data from adult studies, where appropriate, as bridging studies to expand labelling to younger ages. If these …. (shrink)

Japanese constructions of whiteness have been shaped by mainstream media and popular culture, which both reproduces and localizes the western discourse of whiteness. At the same time, the growth of the internet, social media, and online culture have exposed Japan to contentious debates in the United States (and elsewhere) concerning racial representation, race-switching, and diversity, as well as providing a platform for Japanese to reexamine contemporary Japanese racial attitudes. This chapter explores the impact that the discourse of representation and diversity (...) in the United States, the Black Lives Matter (BLM) movement, and demographic changes, particularly the growth of diasporic African communities in Japan since the 1980s, have had on Japanese perceptions of “whiteness,” “blackness,” and “Japaneseness.”. (shrink)

Background This article describes the issues encountered when designing a study to evaluate recruitment of minority ethnic groups into clinical cancer research in order to monitor adherence to the principles for good practice set out in the Department of Health, Research Governance Framework, England. Methods (i) A review of routine data sources to determine whether their usefulness as a source of data on prevalence of cancer in the population by ethnic category. (ii) A local case study at one hospital trust (...) to ascertain whether the ethnicity of cancer trial participants was representative of admitted cancer patients. Results (i) The lack of a comparator population makes it problematic to assess recruitment levels by ethnic group in clinical research. (ii) The odds of being in a trial were 30% lower for a member of a minority ethnic group compared to a white cancer patient after adjusting for disease, age and gender, OR 0.70 (0.53 to 0.94). These results differed for each ethnic group; Asian patients did not appear under-represented while Black and Chinese did so. However, there are important caveats to the findings based on the limited recording of ethnicity. Conclusions The lack of available data on the ethnicity of participants in clinical research and the prevalence of cancer in the population according to ethnicity makes it difficult to design a study to monitor representation of minority ethnic groups. This information is necessary to assess adherence to the Research Governance Framework principle that research evidence reflects the diversity of the population. (shrink)

This article involves a close reading of two African American authors, Zora Neale Hurston, an acclaimed novelist and Katie Cannon, an influential theological ethicist. Texts from Steve Biko on black consciousness and from James Cone on liberation theology are used as methodological tools in trying to ascertain the degree to which Hurston and Cannon espouse a black consciousness. A strong resonance of black consciousness will indeed be found in Hurston’s and Cannon’s texts. The conclusion drawn is that (...) not only is there a resonance of black consciousness, but both writers also give proof of a black womanist consciousness that reveals new knowledge. Cannon’s oeuvre also begs the question of epistemological privilege. In addition, an animated critique is registered between these women scholars and male colleagues, in the world of fiction and academia.Contribution: This article demonstrates a link from South African black consciousness to black womanist thinkers in the United States. A connection is also made between male, black liberation theology and black womanist thinking, while expounding the womanist approach, liberated from male dominance, on par with all others. (shrink)

With increasing complexity in the evolving structure of work in organizations, employees’ preferences for working from home (WFH) relative to working on-site can lead to systematic differences in perceived career implications. An emerging tension associated with WFH versus work-at-work is whether this locational divide is associated with concerns over career progression, especially among racial minorities. Here, we seek to determine whether Black employees, relative to their White counterparts, have more concerns over career progression relating to WFH compared with their (...) on-site colleagues. From a sample of employees in the May 2021 cross-section of the Survey of Working Arrangements and Attitudes (SWAA), we find that relative to higher (lower) income White employees, higher (lower) income Black WFH employees have significantly higher (lower) concerns over career progression than their on-site counterparts. These findings speak both to the nontrivial choices employees may be forced to make as the structure of work continues to evolve and consequences for racial inequality. (shrink)

_Black Intellectual Thought in Education_ celebrates the exceptional academic contributions of African-American education scholars Anna Julia Cooper, Carter G. Woodson, and Alain Leroy Locke to the causes of social science, education, and democracy in America. By focusing on the lives and projects of these three figures specifically, it offers a powerful counter-narrative to the dominant, established discourse in education and critical social theory--helping to better serve the population that critical theory seeks to advocate. Rather than attempting to "rescue" a few (...) African American scholars from obscurity or marginalization, this powerful volume instead highlights ideas that must be probed and critically examined in order to deal with prevailing contemporary educational issues. Cooper, Woodson, and Locke’s history of engagement with race, democracy, education, gender and life is a dynamic, demanding, and authentic narrative for those engaged with these important issues. (shrink)

Macroscopic irreversible processes emerge from fundamental physical laws of reversible character. The source of the local irreversibility seems to be not in the laws themselves but in the initial and boundary conditions of the equations that represent the laws. In this work we propose that the screening of currents by black hole event horizons determines, locally, a preferred direction for the flux of electromagnetic energy. We study the growth of black hole event horizons due to the cosmological expansion (...) and accretion of cosmic microwave background radiation, for different cosmological models. We propose generalized McVittie co-moving metrics and integrate the rate of accretion of cosmic microwave background radiation onto a supermassive black hole over cosmic time. We find that for flat, open, and closed Friedmann cosmological models, the ratio of the total area of the black hole event horizons with respect to the area of a radial co-moving space-like hypersurface always increases. Since accretion of cosmic radiation sets an absolute lower limit to the total matter accreted by black holes, this implies that the causal past and future are not mirror symmetric for any spacetime event. The asymmetry causes a net Poynting flux in the global future direction; the latter is in turn related to the ever increasing thermodynamic entropy. Thus, we expose a connection between four different “time arrows”: cosmological, electromagnetic, gravitational, and thermodynamic. (shrink)

A gas in a box is perhaps the most important model system studied in thermodynamics and statistical mechanics. Usually, studies focus on the gas, whereas the box merely serves as an idealized confinement. The present article focuses on the box as the central object and develops a thermodynamic theory by treating the geometric degrees of freedom of the box as the degrees of freedom of a thermodynamic system. Applying standard mathematical methods to the thermody- namics of an empty box allows (...) equations with the same structure as those of cosmology and classical and quantum mechanics to be derived. The simple model system of an empty box is shown to have interesting connections to classical mechanics, special relativity, and quantum field theory. (shrink)

Through an engagement with Sylvia Wynter, this article explores how black feminist critiques of the human can inform critical genealogies of religion. Specifically, the article develops a theoretical framework to interrogate how the modern construction of religion and the secular also produces racial identities and hierarchies. To draw attention to the global dimensions of this project, the article foregrounds the seminal work of Jason Ā. Josephson-Storm in his book, The Invention of Religion in Japan. The article argues that studies (...) like Josephson-Storm's show how religion helps transform existing forms of social organization within a bio-evolutionary conception of the nation, and is used by the state to differentiate between who can be considered fully human and who cannot. In this process “superstition” or “irrationality” is rewritten as a biological threat to the health and well-being of “the people,” and political domination is represented as a struggle to purify the nation. (shrink)

The verb “to conjure” is a complex one, for it includes in its standard definition a great range of possible actions or operations, not all of them equivalent, or even compatible. In its most common usage, “to conjure” means to perform an act of magic or to invoke a supernatural force, by casting a spell, say, or performing a particular ritual or rite. But “to conjure” is also to influence, to beg, to command or constrain, to charm, to bewitch, to (...) move or convey, to imagine, to visualize, to call to mind, or to remember. —Rachael DeLue 2012, para 1. When we create with our Brown hands, feminine energy, and full spirits, we conjure. To exist, survive, and thrive in these bodies is a continuous act of conjuring. Our walks conjure. Our smiles conjure. Our tears conjure. Our laughs conjure. Our words conjure. Our artworks are conjurings. We, a Black/Filipina-American woman, a Dominican-American, and a Black-American woman, are guided by our solidarity with one another and all other Black and Brown female identifying persons whose raced and gendered subjectivities exist both inside and outside of colonization, white supremacy, and patriarchy. We bring to life our colored imaginations and curiosities, and share them with the world. We are united by our need for safety, autonomy as beings, dissolution of trauma, and desire to ask, “What would happen if I…?” Imaginative, curious Women of Color (WoC) founded the underground railroad, guided captured Africans and Tainos to the mountains, ignited the Civil Rights Movement, organized laborers and immigrants, birthed the #BlackLivesMatter Movement, conceived the #MeToo Movement, and so much more. Like our kindred counterparts, we have an unrelenting urge to examine, question, wonder, desire, speak to, lead, be curious, and “conjure.” As practicing artists and art educators, our critical arts-based practices are grounded in intersectional feminisms like Womanism, Black Feminist Theory, and Chicana Feminist Theory, which allow us to do these very things. (shrink)