Medical, scientific and societal progress has been such that, in a universalist humanist perspective such as the WHO’s, it has become an ethical imperative for the primary endpoints in evidence based health care research to be expressed in e.g. Quality Adjusted Life Years (QALYs). The classical endpoints of discrete health‐related functions and duration of survival are increasingly perceived as unacceptably reductionistic. The major problem in ‘felicitometrics’ is the measurement of the ‘quality’ term in QALYs. That the mental, physical and social (...) domains, each containing many dimensions and items, all contribute to QOL is uncontroversial. What is controversial, is the weight of the different dimensions in overall QOL. It has been shown to be very different between different patient populations. In human individuals, assuredly complex systems, the many dimensions and items of QOL observably interact, probably sometimes also in chaotic ways. In these conditions, the weights of isolated items in individuals become for all practical purposes meaningless. Therefore, the much used multi‐item questionnaires at best describe, but do not evaluate QOL, neither in individuals, nor in populations. For example, allergic patients treated with cetirizine scored better than those a placebo on all dimensions of the SF‐36, a standard QOL questionnaire. Here there is no serious doubt that the treatment improved QOL, because it is highly unlikely that any important dimension on which the patient groups would have scored otherwise is missing in the SF‐36. However, whether piracetam treatment of acute stroke, which improved the surrogate endpoints neurological and functional scores, also improved QOL is plausible, but will be proven only when comprehensive QOL measurement will have been done. And suppose in randomised populations of end‐stage metastatic solid cancer patients, one would compare palliative last‐line chemotherapy with only palliative care, and one would, as can be expected, find no significant differences in average survival, and chemotherapy superior for the mental domain, but inferior for the physical comfort domain: we would not know which treatment, on aggregate, would be the better. The problem is that QOL is an individual and emergent construct, the resultant of a great many intractions, and of a different order than its contributing components. Overall QOL can therefore best be captured only as the Gestalt of a global self‐assessment. Just as people in everyday life, while acting under uncertainty, make global assessments all the time, so they can seriously answer the serious question: ‘How have you been?’ A solemn, practical, non peer‐relativistic, non‐cultural, experiential, and well tolerated way to obtain such responses is Anamnestic Comparative Self Assessment (ACSA), in which the subjects' memories of the best and the worst times in their life experience define their individual scale of QOL. ACSA is thus both exquisitely idiosyncratic, and yet can in a universalist humanistic perspective be considered generic. Using both a multi‐item questionnaire and a global assessment allows by one logistic regression, to estimate the weights of the dimensions and items in populations, and thus identify those whose improvement would most contribute to the QOL of the greatest number. A combined approach to measurement of QOL is necessary to maximise the utility of QOL interventions. (shrink)

Recently, heated discussions about artificial intelligence, creativity, and work have re-emerged. Despite the dominant focus on the novelty of this entanglement, it is rich with history. In this paper, I will first introduce creativity as a historical and socio-culturally embedded concept, looking at how and why we have invented creativity in the guises we have. The focus will mostly be on the political and ideological backdrop of these historical processes–for instance how creativity was repeatedly cast as the positive counterimage of (...) (industrial and bureaucratic) alienated labour, and hence stood in a complex relationship to automation, robotization, and so on. Based on this I will then discuss a series of scenarios that are related to the (perhaps) forthcoming automation of creativity, more specifically four ways in which automation might in different ways impact (the fields of) creative practices and labour. (shrink)

This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but (...) together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. (shrink)

The identification of Smad proteins as molecular components of the transforming growth factor-β (TGF-β) signaling cascade has enhanced our understanding of how ligand-mediated activation of TGF-β receptors leads to modulation of target gene transcription. Recent studies have identified a distinct, structurally related class of Smads which inhibits, rather than transduces, TGF-β family signals. The molecular mechanism of action and the exact signaling pathways that are targeted by antagonistic Smads are not completely understood. These proteins appear to participate in autoregulatory negative (...) feedback loops in which signaling initiated by specific TGF-β family ligands induces the expression of an inhibitory Smad that then functions to modulate the amplitude or duration of signaling. Negative feedback circuits such as these play important roles in fine-tuning the activity of multifunctional signaling molecules during embryonic patterning and in response to pathologic stimuli in adults. BioEssays 21:382–390, 1999. © 1999 John Wiley & Sons, Inc. (shrink)

Data Safety and Monitoring Boards were introduced in the 1960s to monitor data in clinical trials to ensure subject safety. It was thought important that DSMB members be experts in the field of interest, but not otherwise involved in the study in order to maximize objectivity. Since then, the use of DSMBs has increased dramatically, and their scope has expanded to include scientific issues — in particular, to avoid bias that can result when trials are stopped early because of evidence (...) that one treatment has greater efficacy or causes greater harm than another; or that no treatment is likely to do better than any other. (shrink)

During the 1980s many communities turned to grassroots activities to promote economic development, rather than relying on industrial recruitment strategies. We evaluate the characteristics of these projects, their benefits and costs, and obstacles they face in the development process. The data are drawn from a survey of more than one hundred communities in the United States. Self-development efforts do not appear to replace traditional rural economic development activities, but may complement them. Self-development activities produce a wide variety of jobs that (...) are taken primarily by local residents. The cost and availability of credit are major obstacles for self-development projects. Although self-development strategies should not be considered the primary economic development strategy for most rural communities, they do enable communities to build a more viable local economy. (shrink)

The use of quality of life (QOL) outcomes in clinical trials is increasing as a number of practical, ethical, methodological, and regulatory reasons for their use have become apparent. It is important, then, that QOL measurements and differences between QOL scores be readily interpretable. We study interpretation in two contexts: when determining QOL and when basing decisions on QOL differences. We consider both clinical situations involving individual patients and research contexts, e.g., randomized clinical trials, involving groups of patients. We note (...) the ethical importance of such understanding: proper interpretation and communication facilitate health care decision making. Communication that facilitates interpretation is of moral significance since better communication can attenuate ethical problems and inform choices. Much of what is communication worthy about QOL assessments is determined by the particular QOL instrument used in the assessment and how it is administered. In practice, these choices will be driven by the purpose of the assessment, but, it is argued, to maximize understanding, we should combine the information garnered from traditional standardized QOL instruments, from individualized QOL assessments, and from a recently proposed dialogic paradigm, where QOL is determined by shared conversation regarding the interpretation of texts. And, while some studies can surely succeed using abbreviated methods of administration (e.g., postal surveys may suffice for certain purposes), we will focus on methods of administration involving interviewer–respondent interaction. We suggest that during the QOL elicitation process, interviewer and respondent should engage in a two-way conversation in order to achieve a shared understanding of the “answers” to QOL “questions” and, finally, to reach a shared interpretation of the individual’s QOL. (shrink)

Data Safety and Monitoring Boards have been referred to as a “growth industry,” and this trend continues to be fueled by recent FDA guidance and the NIH's requirement that DSMBs be employed in virtually all phase III clinical trials. The widening role of DSMBs has been sporadically questioned on ethical grounds, but growth has continued, despite the fact that many of the questions endure, unanswered, save for repeated references to safeguarding the scientific integrity of trials. This may be about to (...) change. The recently appointed director of the Office for Human Research Protections , Jerry Menikoff, is on record as regarding current practices — where consent forms often promise what the DSMB has been assembled to specifically not provide — as constituting fraudulent behavior. That is, a subject may inherently rely on, to their detriment, information that has been misrepresented in the consent document. In this paper, we assemble some of the enduring questions and top them off with Menikoff's tour de force to present what we hope will be a compelling argument to require that consent forms fairly represent what the DSMB will do — and not do — with trial data as they accumulate. We argue that DSMBs should be used only in rare circumstances, and question the practice of precluding principal investigators from DSMB membership, but our main thrust is to ensure that DSMBs, when used at all, are properly described in trial consent forms. (shrink)

This book is the first to trace the origins and significance of positivism on a global scale. Taking their cues from Auguste Comte and John Stuart Mill, positivists pioneered a universal, experience-based culture of scientific inquiry for studying nature and society—a new science that would enlighten all of humankind. Positivists envisaged one world united by science, but their efforts spawned many. Uncovering these worlds of positivism, the volume ranges from India, the Ottoman Empire, and the Iberian Peninsula to Central Europe, (...) Russia, and Brazil, examining positivism’s impact as one of the most far-reaching intellectual movements of the modern world. Positivists reinvented science, claiming it to be distinct from and superior to the humanities. They predicated political governance on their refashioned science of society, and as political activists, they sought and often failed to reconcile their universalism with the values of multiculturalism. Providing a genealogy of scientific governance that is sorely needed in an age of post-truth politics, this volume breaks new ground in the fields of intellectual and global history, the history of science, and philosophy. (shrink)

This Editorial reports an exchange in form of a comment and reply on the article “History and Nature of the Jeffreys–Lindley Paradox” (Arch Hist Exact Sci 77:25, 2023) by Eric-Jan Wagenmakers and Alexander Ly.

In a recent issue of Philosophy East and West Douglas Berger defends a new reading of Mūlamadhyamakakārikā XXIV : 18, arguing that most contemporary translators mistranslate the important term prajñaptir upādāya, misreading it as a compound indicating "dependent designation" or something of the sort, instead of taking it simply to mean "this notion, once acquired." He attributes this alleged error, pervasive in modern scholarship, to Candrakīrti, who, Berger correctly notes, argues for the interpretation he rejects.Berger's analysis, and the reading of (...) the text he suggests is grounded on that analysis, is insightful and fascinating, and certainly generates an understanding of Nāgārjuna's enterprise that is welcome .. (shrink)

This is a “bottom-up” paper in the sense that it draws lessons in defining disciplinary categories under study from a series of empirical studies of interdisciplinarity. In particular, we are in the process of studying the interchange of research-based knowledge between Cognitive Science and Educational Research. This has posed a set of design decisions that we believe warrant consideration as others study cross-disciplinary research processes.

Agriculture in Western Europe has become efficient and productive but at a cost. The quality of biodiversity, soil, air, and water has been compromised. In the search for ways to ensure food security and meet the challenges of climate change, new production systems have been proposed. One of these is the transition to circular agriculture: closing the cycles of nutrients and other resources to minimise losses and end the impact on climate change. This development aims to address existing problems in (...) food production but also raises questions about animal health and welfare. Although the role animals can play in this development is not ignored, the animal welfare dimension of circular agriculture seems to be overlooked. We argue that this is a problem both for the success of circular agriculture and for the animals involved. To substantiate this claim, we analyse the background to this lack of attention, which we find in (a) the way circular agriculture is conceptualised; (b) the institutional hurdles related to the legal, political and economic context; and (c) the concept of animal welfare, which requires further innovation. By analysing these aspects, we develop stepping stones for an animal-welfare inclusive concept of circular agriculture. These stepping stones include: recognising the animal as a participant with its own interests in the innovation towards circular agriculture; using a dynamic concept of animal welfare; a concept of circularity that provides space for social values, including animal welfare; and attention to institutional innovation by improving public engagement and building trust. (shrink)

Jan Łukasiewicz a élaboré un programme de recherche portant sur l’histoire de la logique. À son avis, la logique mathématique contemporaine (modern) est en continuité directe avec la logique formelle du passé. En conséquence, une interprétation correcte et fidèle des idées anciennes exige une application des outils logiques contemporains. Autrement dit, de bonnes études historiques sur la logique doivent consister à examiner la logique d’autrefois à travers les lunettes logiques contemporaine...

Madhyamaka and Yogacara are the two principal schools of Mahayana Buddhist philosophy. While Madhyamaka asserts the ultimate emptiness and conventional reality of all phenomena, Yogacara is usually considered to be idealistic. This collection of essays addresses the degree to which these philosophical approaches are consistent or complementary. Indian and Tibetan doxographies often take these two schools to be philosophical rivals. They are grounded in distinct bodies of sutra literature and adopt what appear to be very different positions regarding the analysis (...) of emptiness and the status of mind. Madhyamaka-Yogacara polemics abound in Indian Buddhist literature, and Tibetan doxographies regard them as distinct systems. Nonetheless, scholars have tried to synthesize the two positions for centuries. This volume offers new essays by prominent experts on both these traditions, who address the question of the degree to which these philosophical approaches should be seen as rivals or as allies. In answering the question of whether Madhyamaka and Yogacara can be considered compatible, contributors engage with a broad range of canonical literature, and relate the texts to contemporary philosophical problems. (shrink)

Mental models influence how individuals think and act in relation to their external environment and have been identified as leverage points to address sustainability challenges. Given the importance of mental models, a new tool to assess mental models has been developed: the Mental Model Mapping Tool. M-Tool was designed to have a standardized format and to be user-friendly for low literacy populations, using pictograms and audio instructions. In this paper, we evaluate M-Tool’s application in two studies with Tanzanian fishers. In (...) Study 1, we investigated M-tool’s convergent validity compared to standard interviewing methods. Study 2 investigated M-Tool’s construct validity by relating mental model complexity to participants’ education level, a relationship that has been well established. The findings show that mental models produced with M-Tool are more complex than mental models obtained through interviewing techniques; model composition is similar across the two methods; and participants with higher levels of education tend to produce more complex mental models with M-Tool than participants with lower levels of education, in line with previous research. These findings suggest that M-Tool can successfully capture mental models among diverse participants. This tool offers researchers and practitioners an instrument to map and compare perceptions of challenges across groups. (shrink)