Across the world, pain is under-treated in emergency departments. We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under-treatment in the ED is due partly to an epistemic preference for signs over symptoms on the part of some practitioners, and some ED practices that themselves worsen pain (...) by increasing patients' anxiety and fear. Our argument includes the following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under-treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four ED practices that may be contributing to the under-treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include failing to provide orienting information and partially objectifying patients so as to problem-solve along lines pre-established by modern medical science. We conclude by touching on some potential solutions for ED practice. (shrink)

ABSTRACT In keeping with the pre‐eminent status accorded autonomy within Australia, Europe, and the United States, medical practice requires that patients authorize do‐not‐resuscitate (DNR) orders, intended to countermand the default practice in hospitals of instituting cardiopulmonary‐resuscitation (CPR) on all patients experiencing cardio‐pulmonary arrest. As patients typically do not make these decisions proactively, however, family members are often asked to act as surrogate decision‐makers and decide on the patient's behalf. Although the appropriateness of patients or their families having to decide about (...) the provision of CPR has been challenged, there has been little examination of how patients and their families talk about and negotiate such decisions, particularly in the context of the patient's imminent death. In this article, part of a larger study analysing interviews with 28 patients (13 female) with cancer within weeks of their death, and 20 others (predominantly family) attending, we argue that a common assumption underpinning participants' talk about the DNR decision (i.e. forgoing CPR) is that it requires a choice between life and death. Using illustrative examples, we demonstrate that in making decisions about CPR, patients and their families are implicitly required to make moral judgements about the value of the patient's life, including their relationships with significant others. We identify some implications of these empirical observations for the development of ethically appropriate policies and practices regarding patient autonomy and surrogacy at the end of life. (shrink)

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to be actively challenged and reduced. (...) Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma. (shrink)

The link between alcohol consumption and cancer is well established, but public awareness of the risk remains low. Mandated warning labels have been suggested as a way of ensuring “informed choice” about alcohol consumption. In this article we explore various ethical issues that may arise in connection with cancer warning labels on alcoholic beverages; in particular we highlight the potentially questionable autonomy of alcohol consumption decisions and consider the implications if the autonomy of drinking behavior is substantially compromised. Our discussion (...) demonstrates the need for the various ethical issues to be considered and addressed in any decision to mandate cancer warning labels. (shrink)

Background Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting. Methods: how the study was performed and statistical tests used A qualitative case study (...) approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies. Results: the main findings An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Conclusions: brief summary and potential implications Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service’s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating. (shrink)

The classical interpretation of mathematical statements can be seen as comprising two separate but related aspects: a domain and a truth-schema. L. E. J. Brouwer’s intuitionistic project lays the groundwork for an alternative conception of the objects in this domain, as well as an accompanying intuitionistic truth-schema. Drawing on the work of Arend Heyting and Michael Dummett, I present two objections to classical mathematical semantics, with the aim of creating an opening for an alternative interpretation. With this accomplished, I then (...) make the case for intuitionism as a suitable candidate to fill this void. (shrink)

Mechanistic models are built using knowledge as the primary information source, with well-established biological and physical laws determining the causal relationships within the model. Once the causal structure of the model is determined, parameters must be defined in order to accurately reproduce relevant data. Determining parameters and their values is particularly challenging in the case of models of pathophysiology, for which data for calibration is sparse. Multiple data sources might be required, and data may not be in a uniform or (...) desirable format. We describe a calibration strategy to address the challenges of scarcity and heterogeneity of calibration data. Our strategy focuses on parameters whose initial values cannot be easily derived from the literature, and our goal is to determine the values of these parameters via calibration with constraints set by relevant data. When combined with a covariance matrix adaptation evolution strategy, this step-by-step approach can be applied to a wide range of biological models. We describe a stepwise, integrative and iterative approach to multiscale mechanistic model calibration, and provide an example of calibrating a pathophysiological lung adenocarcinoma model. Using the approach described here we illustrate the successful calibration of a complex knowledge-based mechanistic model using only the limited heterogeneous datasets publicly available in the literature. (shrink)

Based on our empirical research on global meaning in people with spinal cord injury and people with stroke, we formulated ‘inner posture’ as a concept in rehabilitation. Inner posture, as we concluded from our empirical data, refers to the way in which people bear what cannot be changed. It helps them to live with their injury. Considering that much has already been written about meaning from a variety of disciplines, the question arises whether the concept of inner posture adds something (...) new to the existing literature, or is just another name for a phenomenon that has already been described before in different terms. In this paper, we aim to investigate this and to clarify our conceptualization, by comparing the concept of inner posture with influential concepts in healthcare literature which seem to be more or less related. In the work of Puchalski regarding spirituality, Pargament regarding religion, Eliott regarding hope and Frankl regarding attitude, we found definitions and descriptions that seemed to come close to the phenomenon we refer to as inner posture. Because these concepts have various theoretical backgrounds, the comparison can help to better understand our concept of inner posture, through a process of dialogue between traditions, following Gadamer’s notion of dialogue as fusion of horizons of understanding. We conclude that inner posture differs from the other concepts in several ways. Some of these differences are more fundamental, other are partial. This suggests that we identified a new perspective on a phenomenon partially described earlier. The comparison also inspired us to slightly adjust our definition and to formulate new research questions. (shrink)

¿Qué significa vivir y filosofar bajo una dictadura militar? Tomaré como punto de partida la experiencia que he compartido con mis amigos chilenos, excluidos o marginados de su universidad, y pronto con otros, argentinos y uruguayos, en las postrimerías de los regímenes autoritarios, una aventura que dura cuarenta años. Al hacerlo, me viene a la memoria la frase de George Eliott que da título al excelente libro de Patrick Vauday, Comenzar. Variaciones sobre la idea de comienzo : “Los hombres (...) no pueden hacer nada sin la ficción de un comienzo”. Es el precio de toda historia o narración, pero “hay sin embargo una necesidad, la de dar cuenta de lo nuevo que no se desprende de lo que le precede sin al menos desviar o derivarse de su línea, como aspirado por lo que aspira a nacer”. (shrink)

A revision of George Kennedy's translation of, introdution to, and commentary on Aristotle's On Rhetoric. His translation is most accurate, his general introduction is the most thorough and insightful, and his brief introductions to sections of the work, along with his explanatory footnotes, are the most useful available.

Recent research on algebraic models of _quasi-Nelson logic_ has brought new attention to a number of classes of algebras which result from enriching (subreducts of) Heyting algebras with a special modal operator, known in the literature as a _nucleus_. Among these various algebraic structures, for which we employ the umbrella term _intuitionistic modal algebras_, some have been studied since at least the 1970s, usually within the framework of topology and sheaf theory. Others may seem more exotic, for their primitive operations (...) arise from algebraic terms of the intuitionistic modal language which have not been previously considered. We shall for instance investigate the variety of _weak implicative semilattices_, whose members are (non-necessarily distributive) meet semilattices endowed with a nucleus and an implication operation which is not a relative pseudo-complement but satisfies the postulates of Celani and Jansana’s strict implication. For each of these new classes of algebras we establish a representation and a topological duality which generalize the known ones for Heyting algebras enriched with a nucleus. (shrink)

Transcript of speeches by a Hindu philosopher, chiefly on Hindu philosophy and Hinduism.

Classical text on Nyaya and Vaiśeṣika philosophy; with Āloka Sanskrit commentary.

Classical work on Vedanta; includes Bhāṣyaratnaprabhā of Govindānanda and Śārīrakamīmāṃsābhāṣya of Śaṅkarācārya.

Classical work on Vedanta by Bādarāyaṇa; includes Śārīraka vijñānam bhāṣya of Śrī Madhusūdana Ojhā.

Purpose. The article is aimed to substantiate the view on the phenomenon of laughter as a subject of semiotic analysis, which leads to the following tasks: to reveal the possibilities of semiotics application in the study of laughter nature; to analyze the phenomenon of laughter as a cultural and natural phenomenon, as a sign and as an attribute; to consider the place of laughter in culture, which is understood as a sign system. Theoretical basis. The semiotic approach proceeds from the (...) fact that human lives in the world of signs, all the surrounding reality can be interpreted as a sign system. The basic concept of semiotics is the concept of a sign. The theoretical basis of the article is understanding the culture as a sign-symbolic system. Laughter is considered as a phenomenon ontologically rooted in human culture. At the same time, laughter is on the edge of culture. The research is based on the work of semiotic authors, cultural researchers, and the researchers of laughter. Originality. The originality lies in the application of the semiotic method to the research of laughter phenomenon, consideration of the dialectics of natural and cultural, signedness and non-signedness, manifested in the phenomenon of laughter. Conclusions. Laughter is considered as a psychophysiological phenomenon and as a cultural phenomenon. Laughter acts as an emotional manifestation, a physiological reaction, but socially and culturally mediated. In any case, laughter indicates an emotional or cognitive state of a human. Laughter acts as a process and result of the interpretation of a sign, a reaction to a sign. Laughter is a form and a means of communication. Being a natural phenomenon, in the process of social evolution, laughter acquires signedness, is integrated by culture as a sign system, and, at the same time, maintains a connection with nature. Thus, laughter occupies an ambivalent position between nature and culture. In the phenomenon of laughter, the dual state of human is revealed. In laughter, boundaries are blurred, the unity and opposition of natural and cultural, biological and social, soul and body, thought and feeling, sign and attribute are manifested. (shrink)

We are immersed within an odorous sea of chemical currents that we parse into individual odors with complex structures. Odors have been posited as determined by the structural relation between the molecules that compose the chemical compounds and their interactions with the receptor site. But, naturally occurring smells are parsed from gaseous odor plumes. To give a comprehensive account of the nature of odors the chemosciences must account for these large distributed entities as well. We offer a focused review of (...) what is known about the perception of odor plumes for olfactory navigation and tracking, which we then connect to what is known about the role odorants play as properties of the plume in determining odor identity with respect to odor quality. We end by motivating our central claim that more research needs to be conducted on the role that odorants play within the odor plume in determining odor identity. (shrink)

Eco-labels emphasize information disclosure as a tool to induce environmentally friendly behaviors by both firms and consumers. The goal of eco-labels is to reduce information asymmetry between producers and consumers over the environmental attributes of a product or service. However, by focusing on this information asymmetry, rather than on how the label meets consumer needs, eco-labels may send irrelevant, confusing, or even detrimental messages to consumers. In this article, the authors investigate how the environmental signal of eco-labels interacts with product (...) characteristics such as brand, quality, and price. In a discrete choice experiment, the authors examine consumer response to two similar eco-labels for wine, one associated with a quality reduction and the other not. The results show that respondents preferred both eco-labeled wines over otherwise identical conventional counterparts when the price was lower and the wine was from a lower quality region. However, they preferred conventional, more expensive wine from a high-quality region. This preference indicates that respondents not only obtain some warm glow value from eco-labeled wine but also possibly interpret eco-labeling as a signal of lower quality. This relationship held across both types of eco-labels, meaning that consumers did not understand the difference between them. This research contributes to the literature on information disclosure policies by highlighting important elements for effective eco-labels. These elements include consumer awareness and understanding of the eco-label, and consumer willingness to pay for an eco-labeled product. The results emphasize the need to create eco-labels that communicate clearly both the environmental attributes and the private benefits associated with them. (shrink)

This book completes medical care by adding the comprehensive humanistic perspectives and philosophy of medicine.

Purpose. To consider the uniqueness of Descartes’ way of interpreting poetry as a type of philosophizing that makes it possible to comprehend the metaphysical nature of man. Its implementation involves the consistent solution of the following tasks: a) understanding methodological changes in the philosophy of the 20th century in the process of actualization of anthropological interest; b) argumentation of the importance of poetic thinking for early Descartes in the process of addressing modern historians of philosophy and the thinker’s texts. Theoretical (...) basis. I rely on the conceptual positions of phenomenology, existentialism and hermeneutics. Originality. Finding of the study is that poetic thinking is the most authentic way of meaningful comprehension of the metaphysicity of man. The paper outlines the nature of the expression of this correlation in the philosophizing of the 20th-21th centuries and substantiates the thesis about the importance of the poetic principle for understanding the phenomenon of man in early works by Descartes. Conclusions. The paper examined the methodological shifts in anthropologically oriented philosophizing of the 20th-21th centuries and focused on the manifestations of related moments in the philosophical legacy of Descartes. The latter demonstrates the existence of a still underestimated version of interpreting the metaphysical foundations of human existence, the form of understanding of which is poetic thinking. It is a form of caring for the humane in man. (shrink)

Basic work on Vedanta philosophy; with Sanskrit commentary with Hindi translation.

Clark and Fischer's three levels of depiction of social robots can be conceptualized as cognitive schemas. When interacting with social robots, humans shift between schemas similarly to how they shift between identity category schemas when interacting with other humans. Perception of mind, context cues, and individual differences underlie perceptions of which level of depiction is most situationally relevant.