This paper proposes a generalization of the Kripke semantics of intuitionistic logic IL appropriate for intuitionistic Łukasiewicz logic IŁL — a logic in the intersection between IL and (classical) Łukasiewicz logic. This generalised Kripke semantics is based on the poset sum construction, used in Bova and Montagna (Theoret Comput Sci 410(12):1143–1158, 2009) to show the decidability (and PSPACE completeness) of the quasiequational theory of commutative, integral and bounded GBL algebras. The main idea is that w \Vdash \sigma—which for IL is (...) a relation between worlds w and formulas \sigma, and can be seen as a function taking values in the booleans w \Vdash \sigma \in {B}—becomes a function taking values in the unit interval w \Vdash \sigma \in [0,1]. An appropriate monotonicity restriction (which we call sloping functions) needs to be put on such functions in order to ensure soundness and completeness of the semantics. (shrink)

Frente a una América Latina movilizada, conflictuada y atravesada por conatos de violencia interactoral, cívica-contestataria y política, y ante los abusos de gobiernos que resultan en reclamos y nuevas prácticas políticas de los sujetos sin derechos, se genera un escenario de riesgo para la endeble democracia. En virtud de esto el autor analiza la democracia no sólo en torno a los procesos y eventos electorales sino tambi{en abarcando otras aristas de este fenómeno, como la participación, las movilizaciones, los nuevos actores (...) y los comportamientos de las multitudes, buscando dar cuenta sobre los riesgos de la democracia. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

One approach to validating simulation models is to formally compare model outputs with independent data. We consider such model validation from the point of view of Frequentist statistics. A range of estimates and tests of goodness of fit have been advanced. We review these approaches, and demonstrate that some of the tests suffer from difficulties in interpretation because they rely on the null hypothesisHypothesis that the model is similar to the observationsObservations. This reliance creates two unpleasant possibilities, namely, a model (...) could be spuriously validated when dataData are too few, or inappropriately rejected when data are too many. Finally, these tests do not allow a principled declaration of what a reasonable level of difference would be considering the purposes to which the model will be put. We consider equivalence tests, and demonstrate that they do not suffer from the previously identified shortcomings. We provide two case studies to illustrate the claims of the chapter. (shrink)

Biomedical innovation and translation are increasingly emphasizing research using “big data.” The hope is that big data methods will both speed up research and make its results more applicable to “real-world” patients and health services. While big data research has been embraced by scientists, politicians, industry, and the public, numerous ethical, organizational, and technical/methodological concerns have also been raised. With respect to technical and methodological concerns, there is a view that these will be resolved through sophisticated information technologies, predictive algorithms, (...) and data analysis techniques. While such advances will likely go some way towards resolving technical and methodological issues, we believe that the epistemological issues raised by big data research have important ethical implications and raise questions about the very possibility of big data research achieving its goals. (shrink)

We examine the problem of deducing the geodesic motion of test particles from Einstein's vacuum field equations and its extension to include gravitational radiation reaction. In the latter case we obtain an equation of motion for a particle which incorporates radiation reaction of the electrodynamical type, but due to shearing radiation, together with a mass-loss formula of the Bondi-Sachs type.

Previous research has suggested that individuals who identify as being more religious request more aggressive medical treatment at end of life. These requests may generate disagreement over life-sustaining treatment (LST). Outside of anecdotal observation, however, the actual role of religion in conflict over LST has been underexplored. Because ethics committees are often consulted to help mediate these conflicts, the ethics consultation experience provides a unique context in which to investigate this question. The purpose of this paper was to examine the (...) ways religion was present in cases involving conflict around LST. Using medical records from ethics consultation cases for conflict over LST in one large academic medical centre, we found that religion can be central to conflict over LST but was also present in two additional ways through (1) religious coping, including a belief in miracles and support from a higher power, and (2) chaplaincy visits. In-hospital mortality was not different between patients with religiously versus non-religiously centred conflict. In our retrospective cohort study, religion played a variety of roles and did not lead to increased treatment intensity or prolong time to death. Ethics consultants and healthcare professionals involved in these cases should be cognisant of the complex ways that religion can manifest in conflict over LST. (shrink)

Books and articles about the acceleration of daily life are themselves accelerating. A theoretical basis for expecting the inevitability of these trends has been traced in the writings of major sociologists including Durkheim, Marx, Weber and Sorkin. As deTocqueville observed more than 150 years ago, “The American is always in a hurry.” Economists have also weighed in on these issues of time compression, perhaps starting with Linder’s insightful treatise The Harried Leisure Class, predicting the frantic pace of modern life and (...) leisure. As specialized work led to higher rates of productivity, accelerated consumption led to an acceleration of the pace of life and a harried leisure class. Much of what Linder discussed in regard to time scarcity was perceived scarcity. Interestingly, his conclusions were not that people would work longer, but rather that they would attempt to increase the yield on a unit of time in all areas of life—minimizing activities such as singing or political debate, which could not easily have their yield on time spent increased. The value of efficiency and increased productivity, carried to extremes, he argued, produced a kind of decadence in which the goal of economic growth is never questioned. More recently, economists have played down the seriousness of concerns over a speeded up lifestyle, characterizing it in large part as “Yuppie Kvetch.” Not that higher income couples are making irrational decisions, they are simply facing the inevitable constraints on their ability to enjoy their wealth. This article reviews various of these philosophical issues in the context of US national survey data concerning trends in the time pressures and stress in the activities of Americans over the last 30+ years. It focuses both on the measurable amounts of free time Americans have and on the specific activities done in that free time. It also reviews survey data on Americans’ perceptions of and attitudes toward time and stress. It brings together data from different survey sources that often show conflicting trends and conclusions. (shrink)

We applaud the goals and execution of the target article, but note that individual differences do not receive much attention. This is a shortcoming because individual differences can play a vital role in theory testing. In our commentary, we describe programs of research of this type and also apply similar thinking to the mechanisms proposed in the target article.

The European Clinical Trials Directive was issued in 2001 and aimed to simplify and harmonise the regulatory framework of clinical trials throughout Europe, thus stimulating European research. However, significant complexity and inconsistency remains due to disparate interpretation by EU member states. Critical care research has been particularly impacted due to variable and often restrictive consenting procedures for incapacitated subjects, with some countries requiring a court-appointed representative, while others recognise consent from family members and occasionally professional representatives. Furthermore, the absence of (...) a waiver of consent threatened to put an end to emergency research in Europe and was met with varied responses. Approval procedures by ethics committees are equally inconsistent, particularly those relating to provision of a single opinion for multi-centre trials. Although evidence is somewhat mixed, this complexity as well as a general increase in administrative and financial burden following the Directive has been shown to cause a reduction in clinical trial activity in Europe, particularly academic trials. We aim to clarify some of these inconsistent procedures, particularly those relating to informed consent of incapacitated subjects, as well as discussing some general weaknesses and possible improvements of the Directive ahead of its planned revision in 2011. (shrink)

Research aimed at developing and validating an instrument to assess secondary school students? perceptions of assessment tasks was conducted. Following a review of literature, a five?scale instrument of 40 items was trialled with a sample of 658 science students in 11 English secondary schools. Based on internal consistency reliability data and exploratory factor analysis, refinement decisions resulted in a five?scale instrument called the Perceptions of assessment tasks inventory (PATI). The scales of the PATI are Congruence with planned learning, Authenticity, Student (...) consultation, Transparency and Diversity. (shrink)

In cortical neurones, analogue dendritic potentials are thought to be encoded into patterns of digital spikes. According to this view, neuronal codes and computations are based on the temporal patterns of spikes: spike times, bursts or spike rates. Recently, we proposed an ‘action potential waveform code’ for cortical pyramidal neurones in which the spike shape carries information. Broader somatic action potentials are reliably produced in response to higher conductance input, allowing for four times more information transfer than spike times alone. (...) This information is preserved during synaptic integration in a single neurone, as back‐propagating action potentials of diverse shapes differentially shunt incoming postsynaptic potentials and so participate in the next round of spike generation. An open question has been whether the information in action potential waveforms can also survive axonal conduction and directly influence synaptic transmission to neighbouring neurones. Several new findings have now brought new light to this subject, showing cortical information processing that transcends the classical models. BioEssays 29: 178–187, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

We describe the structure, operation, and experience of the Massachusetts General Hospital ethics committee, formally called the Edwin H. Cassem Optimum Care Committee, from January 2007 through December 2013. Founded in 1974 as one of the nation’s first hospital ethics committees, this committee has primarily focused on the optimum use of life-sustaining treatments. We outline specific sociodemographic and clinical characteristics of consult patients during this period, demographic differences between the adult inpatient population and patients for whom the ethics committee was (...) consulted, and salient features of the consults themselves. We include three case studies that illustrate important consult themes during this period. Our findings expand knowledge about the structure and workings of hospital ethics committees and illustrate how one ethics committee has developed and utilized policies on end-of-life care. More generally, we model a sociological approach to the study of clinical ethics consultation that could be utilized to contextualize institutional practices over time. (shrink)

Anxiety and stress-related disorders constitute a large global health burden, but are still poorly understood. Prior work has demonstrated clear impacts of stress upon basic cognitive function: biasing attention toward unexpected and potentially threatening information and instantiating a negative affective bias. However, the impact that these changes have on higher-order, executive, decision-making processes is unclear. In this study, we examined the impact of a translational within-subjects stress induction (threat of unpredictable shock) on two well-established executive decision-making biases: the framing effect (...) (N = 83), and temporal discounting (N = 36). In both studies, we demonstrate (a) clear subjective effects of stress, and (b) clear executive decision-making biases but (c) no impact of stress on these decision-making biases. Indeed, Bayes factor analyses confirmed substantial preference for decision-making models that did not include stress. We posit that while stress may induce subjective mood change and alter low-level perceptual and action processes (Robinson et al., 2013c), some higher-level executive processes remain unperturbed by these impacts. As such, although stress can induce a transient affective biases and altered mood, these need not result in poor financial decision-making. (shrink)

The COVID‐19 pandemic has placed extraordinary stress on frontline healthcare providers as they encounter significant challenges and risks while caring for patients at the bedside. This study used qualitative research methods to explore nurses and respiratory therapists' experiences providing direct care to COVID‐19 patients during the first surge of the pandemic at a large academic medical center in the Northeastern United States. The purpose of this study was to explore their experiences as related to changes in staffing models and to (...) consider needs for additional support. Twenty semi‐structured interviews were conducted with sixteen nurses and four respiratory therapists via Zoom or by telephone. Interviews were transcribed verbatim, identifiers were removed, and data was coded and analyzed thematically. Five major themes characterize providers' experiences: a fear of the unknown, concerns about infection, perceived professional unpreparedness, isolation and alienation, and inescapable stress and distress. This manuscript analyzes the relationship between these themes and the concept of moral distress and finds that some, but not all, of the challenges that providers faced during this time align with previous definitions of the concept. This points to the possibility of broadening the conceptual parameters of moral distress to account for providers' experiences of treating patients with novel illnesses while encountering institutional and clinical challenges. (shrink)

The emotion of anger, when chronic, is especially problematic. Frequent and intense experiences of anger predict quite a few adverse health outcomes and are especially implicated in cardiovascular...

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two. This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated by (...) painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings. (shrink)

Back injuries have a bad reputation. The workman looks upon them with apprehension, the insurance company with doubt, the medical examiner with suspicion, the lawyer with uncertainty. The medical examiner is faced with the difficulty of estimating the true value of the subjective symptoms in the comparative absence of physical signs. His suspicion is born of the frequent disparity between these two. This prophetic statement made almost 100 years ago highlights an ongoing problem - how people who are incapacitated by (...) painful conditions such as chronic low back pain can be evaluated consistently and equitably for purposes of disability compensation. We confronted this vexing problem when we participated in writing the chapter devoted to impairment associated with pain of the American Medical Association s Guides to the Evaluation of Permanent Impairment, 5th edition AMA Guides 5th Our purposes in this essay are to clarify several important conceptual issues associated with the assessment of pain among disability applicants, and to articulate reasons why pain should be considered in impairment and disability ratings. (shrink)