These remarks, which span the last eighteen months of Wittgenstein’s life, extend several of his well known themes from his so-called "later" writings. One such theme, which occurs as a unifying leitmotiv in this work, is that philosophical puzzlement arises from a failure to realize the indefiniteness and complexity of our concepts. Herein it takes the form of the claim that we have not one but several concepts of color. In fact, we have as many concepts of color as we (...) have different methods for determining sameness of color. "The indefiniteness in the concept of color lies, above all, in the indefiniteness of the concept of the sameness of colors, i.e., of the methods of comparing colors". E.g., when I say of two objects that they have the same color I could mean, among other things, that they visually appear to be similar or that their surfaces are painted with similarly tinted paints. Another prominent theme, which runs throughout all of his writings, both early and late, is the employment of a linguistic or grammatical theory of necessity for the purpose of refuting claims to have synthetic a priori knowledge. Herein it is phenomenology which is put in its place, its claims turning out to be only an "analysis of concepts that can neither agree with nor contradict physics". The indefiniteness in our concept of color helps spawn the illusion of such exalted knowledge, because it enables us to use a single sentence, on some occasions, to express a norm or convention of language and, on others, to report experience. "Sentences are often used on the borderline between logic and the empirical, so that their meaning changes back and forth and they count now as expressions of norms, now as expressions of experience". Considerable space is devoted to showing that the sentence "A body cannot seem to be both white and transparent" is used in the former way. While Wittgenstein succeeds in saying many interesting and original things about color, his remarks do not give any further clarification to the underlying themes, such as the two above, which he deploys in this area.—R.M.G. (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)

The attitudes of patients' to consent have changed over the years, but there has been little systematic study of the attitudes of anaesthetists and surgeons in this process. We aimed to describe observations made on the attitudes of medical professionals working in the UK to issues surrounding informed consent.

Since its inception in 2010, the Network for Public Health Law has aligned with federal, state, tribal, and local public health practitioners to assess how law can promote and protect the public’s health. In 2013, Network authors illustrated major trends in public health laws and policies emanating from an internal assessment of thousands of requests for technical assistance nationally. More recently, the Robert Wood Johnson Foundation has invited the Network and other partners to consider new ideas and strategies toward building (...) a “culture of health.” Per Figure 1, RWJF’s conception of a culture of health emphasizes key action areas essential to the promotion of health across all sectors and diverse populations. (shrink)

We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...) daily lives (e.g., home ventilation) present to acute care hospitals, their personal ventilators should not be reallocated to other patients. Fifth, designate triage officers to assess patients individually on the basis of objective medical evidence, not stereotypes or assumptions. Sixth, include disability rights advocates in policy development and dissemination. (shrink)

The aim of this chapter is to address the role of memory in past-life convictions. Although it is commonly accepted in the modern media - and popular western culture more generally - that people believe they have lived before because the memory contains detailed verifiable facts, little is known about how people actually reason about the veracity of their previous existence. To our knowledge, the current project is the most extensive research that probes the role of memory in past life (...) convictions. More specifically, we explore two questions. First, to what extent does memory lead to past-life belief, and is this conviction based on external validation or via the episodic sense of personal identity contained in the memory? Second, what is the conception of self on which one's current self is taken to be the same as the past-life self? -/- In what follows, we propose that memory plays an important role in convincing people that they have lived before. Fundamentally, this memory is episodic insofar as it represents the event as happened to the encoder. This memory contrasts with semantic memory - memory of facts...Further, we contend that it is the episodic sense of personal identity (rather than external validation) that typically contributes to the belief in a past life. Finally, we argue that the conception of self implicated in past-life belief is the non-trait conception. Of course, this fits naturally with the idea that the belief in a past life issues partly from the episodic sense of identity, since it is the non-trait conception of self that is implicated in the episodic sense of identity... -/- Our proposal in this chapter can be construed as a psychological extension of Reid's point in the context of past-life belief. People assume that they are the same person as someone in earlier times, despite large variations in the traits between those individuals, and they think this partly because of the testimony of their episodic memory. If our account is correct, then it makes the belief in a past life less bizarre, at least psychologically. For we are suggesting that the episodic sense of personal identity that led to your conviction that you existed at the time of your sixteenth birthday celebrations some decades ago, is also involved in other people's convictions that they existed 200 years ago. This proposal is also situated in recent cognitive approaches to the study of religion and religious experiences, which suggests that extraordinary convictions are often underpinned by the ordinary processes of social cognition (e.g. see Barrett 2000; Barrett 2007; Boyer 2001; Lawson and McCauley 1990; for reincarnation, see White Forthcoming-a,-b). (shrink)

The Aristotelian-Thomist claim is that external actions can be morally evaluated when they are voluntary (which includes being based on reasonably accurate knowledge of what an agent is doing), absent which, in effect, we evaluate outcomes, not acts. Also, in the Aristotelian-Thomist tradition the internal act of the will is paramount. These claims contrast with some current theorizing, e.g., by Judith Jarvis Thomson, that morally evaluates actions separately from agents, downplaying the internal act. Taking cases from current authors that revolve (...) around ignorance of key facts, I critique their theorizing on the basis of the nature of agency, the nature of abstraction, the moral language we use in describing acts, the need for reasonably complete descriptions of acts, and the tendency of act evaluations to “leak” into agent evaluations in objective theories. I then describe how Thomas Aquinas’s account of moral evaluation avoids these problems and provides a superior, multi-dimensional framework for moral evaluation. (shrink)

The Aristotelian-Thomist claim is that external actions can be morally evaluated when they are voluntary, absent which, in effect, we evaluate outcomes, not acts. Also, in the Aristotelian-Thomist tradition the internal act of the will is paramount. These claims contrast with some current theorizing, e.g., by Judith Jarvis Thomson, that morally evaluates actions separately from agents, downplaying the internal act. Taking cases from current authors that revolve around ignorance of key facts, I critique their theorizing on the basis of the (...) nature of agency, the nature of abstraction, the moral language we use in describing acts, the need for reasonably complete descriptions of acts, and the tendency of act evaluations to “leak” into agent evaluations in objective theories. I then describe how Thomas Aquinas’s account of moral evaluation avoids these problems and provides a superior, multi-dimensional framework for moral evaluation. (shrink)

J P White; Indoctrination, Journal of Philosophy of Education, Volume 4, Issue 1, 30 May 2006, Pages 107–120, https://doi.org/10.1111/j.1467-9752.1970.tb00429.x.

Introduction: Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted. Objectives: The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes. Methods: Data from 10,472 adults in the National Health and (...) Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression. Results: A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test, and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old. Conclusion: Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications. Knowledge Transfer Statement: Screening for prediabetes and diabetes during dental visits has the potential to raise patients’ awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being. (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)

A child’s death is a profound loss for mothers and affects hundreds of thousands of women. Mothers report inconsolable and progressive grief that is distinct from depression and impacts daily emotions and functions. The brain mechanisms responsible for this relatively common and profound mental health problem are unclear, hampering its clinical recognition and care. In an initial exploration of this condition, we used resting state functional MRI (fMRI) scans to examine functional connectivity in key circuits, and task-based fMRI to examine (...) brain network activity in grieving mothers in response to pictures of their deceased child and as well as recognizable deceased celebrities and unfamiliar individuals. We compared nine mothers who had lost an adult child and aged-matched control mothers with a living child of a similar age. Additionally, we collected diffusion imaging scans to probe structural connectivity and complemented the imaging studies with neuropsychological assessments. Increased functional activation in Ventral Attention/Salience Networks accompanied by a reduced activation in the medial prefrontal cortex in response to the deceased child’s picture robustly distinguished the grieving mothers from controls. Heightened resting-state functional connectivity between the paraventricular thalamic nucleus (PVT) and the amygdala distinguished the grieving mothers from the controls and correlated with subjective grief severity. Structurally, maternal grief and its severity were associated with alterations in corticolimbic white matter tracts. Finally, grieving mothers performed worse than controls on neuropsychological tests of learning, memory, and executive function, linked with grief severity. Reduced activation in cortical regions inhibiting emotions and changes in the PVT circuitry—a region involved in long-term emotional memories and decision making under conflict—distinguish grieving mothers from controls. Notably, the magnitude of neurobiological changes correlates with the subjective severity of grief. Together, these new discoveries delineate a prevalent and under-recognized mental health syndrome and chart a path for its appreciation and care. (shrink)

I. INTRODUCTION: THE PROBLEMAkrasia (or, weakness of the will), often defined as “the moral state of agents who act against their better judgment”—a definition first given by Aristotle in the Nicomachean Ethics, depicts one of the most human of predicaments.Risto Sarrinen, Weakness of the Will in Medieval Thought: From Augustine to Buridan (New York: E. J. Brill, 1994), p. 1. Similar definitions can be found in, e.g., Aristotle, Nicomachean Ethics VII, 1045b10–15; Donald Davidson, “How is Weakness of the Will Possible?” (...) in Moral Concepts, ed. J. Feinberg (Oxford: Oxford University Press, 1970) p. 93; William Charlton, Weakness of Will (Oxford: Basil Blackwell, 1988), p. 1. We know what we ought to do, and we try. But, for one reason or other, we sometimes choose to act contrary to our better judgment.Being influenced by Socratic reasoning, some philosophers have argued that, in principle, one cannot freely and intentionally choose to act against one’s better judgment, if (1) one rationally judges what is best for oneself, (2) one prefers to act according to one’s rational judgment, and (3) one is free to make one’s own choice. See, e.g., Davidson, “How is Weakness,” pp. 93–113; and R. M. Hare, Freedom and Reason (Oxford: Oxford University Press, 1963), pp. 78–79. Despite the logical difficulty, many believe that weakness of the will is a fact. (shrink)

This article examines mixed ℋ -infinity and passivity synchronization of Markovian jumping neutral-type complex dynamical network models with randomly occurring coupling delays and actuator faults. The randomly occurring coupling delays are considered to design the complex dynamical networks in practice. These delays complied with certain Bernoulli distributed white noise sequences. The relevant data including limits of actuator faults, bounds of the nonlinear terms, and external disturbances are available for designing the controller structure. Novel Lyapunov–Krasovskii functional is constructed to verify (...) the stability of the error model and performance level. Jensen’s inequality and a new integral inequality are applied to derive the outcomes. Sufficient conditions for the synchronization error system are given in terms of linear matrix inequalities, which can be analyzed easily by utilizing general numerical programming. Numerical illustrations are given to exhibit the usefulness of the obtained results. (shrink)

IntroductionCerebral visual impairment is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according (...) to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23. 2. Ophthalmological and orthoptic assessment 37. 3. Neuropsychological assessment 5. 4. Neuroradiological evaluation and magnetic resonance imaging 9. 5. Genetic assessment 5.ConclusionIn medical history taking, prematurity low birth weight and APGAR Scores are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups. In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments can be necessary to complete the diagnosis of CVI and/or to reveal the etiology. (shrink)

This paper is a critical review of Mitchell Green’s Self-Expression . The principal focus is on Green’s contention that all expression is at route, a form of signalling by an agent or by some mechanism of the organism which has been evolutionary selected for signalling. Starting from the idea that in some but not all expression an agent seeks to express his or her self, I question the centrality of communication to the idea of expression.

The aim of Nordenstam’s capable but compact book is to examine the analytic-synthetic distinction and its relationship to empiricism in light of the criticisms expressed by W. V. Quine’s "Two Dogmas of Empiricism," M. G. White’s "The Analytic and the Synthetic: An Untenable Dualism," and N. Goodman’s "On Likeness of Meaning." Nordenstam cites Pasch’s summary of the controversy: "Empiricism presupposes a sharp distinction between analytic and synthetic statements. There is no sharp distinction between analytic and synthetic statements in natural (...) languages but only in artificial languages. But the artificial language approach is incompatible with empiricism. Therefore, empiricism has to be abandoned, or at least it has to be modified." In addressing this argument, Nordenstam begins with an explication of some of the basic concepts: the various interpretations of the principle of analyticity, the gradualist positions of Quine et al., the principle of empiricism, and the relationship between these two principles. From this analysis he concludes that one can legitimately hold the principle of empiricism and still reject the principle of analyticity, thereby denying the first assumption of the above argument. Focusing attention on the opposition to the analytic-synthetic distinction, he introduces a number of criticisms by Quine et al. of some twelve common definitions of "analytic statement" involving the notions of synonymy, state-descriptions, and semantical rules of artificial languages. Here Nordenstam’s suggestion is that the resultant criteria of analyticity and synonymy demanded by Quine et al. are excessively stringent. (shrink)