Background: Patients in a vegetative state pose problems in diagnosis, prognosis and treatment. Currently, no prognostic markers predict the chance of recovery, which has serious consequences, especially in end-of-life decision-making. Objective: We aimed to assess an objective measurement of prognosis using advanced electroencephalography (EEG). Methods: EEG data (19 channels) were collected in 14 patients who were diagnosed to be persistently vegetative based on repeated clinical evaluations at 3 months following brain damage. EEG structure parameters (amplitude, duration and variability within (...) quasi-stationary segments, as well as the spatial synchrony between such segments and the strength of this synchrony) were used to predict recovery of consciousness 3 months later. Results: The number and strength of cortical functional connections between EEG segments were higher in patients who recovered consciousness (P < .05 – P < .001) compared with those who did not recover. Linear regression analysis confirms that EEG structure parameters are capable of predicting (P = .0025) recovery of consciousness 6 months post-injury, whereas the same analysis failed to significantly predict patient outcome based on aspects of their clinical history alone (P = .629) or conventional EEG spectrum power (P = .473). Conclusions: The result of this preliminary study demonstrates that structural strategy of EEG analysis is better suited for providing prognosis of consciousness recovery than existing methods of clinical assessment and of conventional EEG. Our results may be a starting point for developing reliable prognosticators in patients who are in vegetative state, with the potential to improve their day-to-day management, quality of life, and access to early interventions. (shrink)

The article presents social simulation from theoretical and philosophical perspectives as a prognostic tool for researching, analysing and anticipating communication and other processes in social environments. The first part discusses the phenomena of ontological and epistemological simulation, treating social simulation processes as epistemological ones. The second part analyses the attitude of the French sociologist and media philosopher Jean Baudrillard towards social simulation, which he himself treats as ontological one. The counterarguments to introduce Baudrillard’s unidentified distinction between ontological and epistemological (...) simulation processes are presented. The third part deals with the principles of the functioning of social simulations as a prognostic tool and provides analytical possibilities for various social environments, communication and other processes. At the end of the article, it is concluded that Baudrillard’s concept of ontological simulation, which annihilates classical Western metaphysics, erroneously reduces the difference between ontos and epistēmē. (shrink)

Introduction. The article is focused on analyzing the utopian direction of Russian cosmism and its influence on the Soviet cosmonautics and the development of society in the USSR. This philosophical theory was created in the period that made it possible to incorporate the applied aspects of utopia into scientific and technological progress and thereby embody a number of steps towards the outer space exploration. The authors have developed criteria and parameters for assessing the utopian component of the Russian cosmism theories, (...) which made it possible to bring this construct to a higher level of abstraction and thereby create a working model for conducting such studies in the context of other utopias of models. The purpose of the article is to show the influence of the Russian cosmism utopia on the cosmonautics development in the USSR, develop empirical criteria for evaluating the phenomenon. Achieving the goal required solving the following tasks: 1) considering and analyzing the subject matter of the cosmism utopia; 2) developing parameters for assessing the impact of utopia on the development of the social system; 3) applying the developed parameters to assess the impact of utopian ideas on the development of the Soviet cosmonautics system. Methods. Developing the theoretical model for assessing social utopias, as well as considering and analyzing the cosmism utopia, required the use of structural-functional and systems analysis. The research was conducted within the framework of a synergistic paradigm. Scientific novelty of the research. The article conceptualizes the concept of utopia. It is shown that most of the definitions of utopia as a socio-political ideal focus on the limitations of its existence: utopia cannot be embodied, often has an unscientific character, does not correlate with the real state of the system, i.e. definitions of utopia are often reduced to the negative format. The authors believe that the influence of utopia on society, as a rule, is positive. It is noted that, along with limitations, utopianism has certain unique essential features that qualitatively affect the social projects implementation. Utopia in the systemic understanding acts as a complex of ideas influencing the development of the system, being both internal (since it is created artificially and consciously by the very elements of the system) and an external factor of influence. Unlike Plato’s eidos, the projection of which is reality, utopia is created inductively, but after its creation it again “descends” to the level of reality, since it begins to influence the social model in which it was created. Results. The article discusses the prognostic and modeling functions of the social utopias of Russian cosmists. It has been proved that one of the essential functions of the Russian cosmism utopias is the formation of an ideal type, towards which, in a historical perspective, the real social system begins to strive. It is convincingly demonstrated that utopia acts as a cognitive support and inevitably forms the canvas along which society begins to move, defining the utopian model as an attractor, although such a goal is not always formulated when creating a utopia. This relationship makes it possible to assess the degree of influence of utopian ideas on the formation of reality in each specific case, which, in turn, provides an opportunity to answer the question of how and to what extent the utopian ideal type participates in determining the characteristics and parameters of a real social system. Conclusions. It was found that the social utopia of cosmists as a cognitive concept is an important effective factor influencing the development of the space industry in the USSR. The parameters adopted in the study allow us to describe the measure of its influence as both an internal and an external factor on the development of the society in which it is implemented. The validity of perceiving the utopia of cosmists as a construct with a certain life cycle, the main part of which is the period of functioning, is stated. During this time period, utopian theory can have a significant impact on the actual development of society from various angles. (shrink)

Figner, Mackinlay, Wilkening, and Weber (2009) developed the Columbia Card Task (CCT) to measure risk-taking attitudes. This tool consists of two versions: in the COLD version the decision maker needs to state in advance how many cards (out of 32) they want to turn over (so called static risk taking), in the HOT version they have the possibility of turning over all 32 cards one-by-one until they decide to finish (dynamic risk taking). We argue that the HOT version confounds an (...) individual’s willingness to accept risk with their beliefs in trend continuation vs. trend reversal in a prognostic task. In two experimental studies we show that people believing in trend continuation (momentum subjects) turn over more cards than those believing in trend reversal (contrarians) in the HOT version of the task. However, this is not the case in the COLD version. Thus, we provide evidence that, when considered as a dynamic risk propensity measure, the number of turned over cards in the HOT version of the CCT is a contaminated measure and reflects two phenomena: (1) risk preference and (2) the decision-maker’s belief in trend continuation. We speculate that other dynamic risk taking measures can also be biased by a momentum strategy. (shrink)

As a neonatal neurologist, I serve families facing tragic decisions in which they must balance trade-offs between death and life with profound disability. I often find myself in complex discussions about future outcome, in which families sort through in real-time what information they value most in making such a choice. Will he laugh? Will he be in pain? Will he know how much he’s loved? In this month’s feature article, Brick et al share the results of an online survey aimed (...) at assessing public views on when a life is not worth living, in an effort to inform ongoing legal and clinical debates about withdrawal of life-sustaining treatment for children. These findings raise important questions about how we define and measure outcomes that matter to parents as they make these tragic decisions. It is challenging to interpret these findings in the absence of context of how decision-making for infants occurs in real-time. The nature of this study and its objective required that cases be substantially simplified. As the authors acknowledge, the prognoses and function of the children involved in these cases were often deeply contested. Prognostic uncertainty is common for children with significant …. (shrink)

Background: Magnetic resonance spectroscopic imaging is a neuroimaging technique that may be useful for non-invasive mapping of brain temperature over a large brain volume. To date, intra-subject reproducibility of MRSI-based brain temperature has not been investigated. The objective of this repeated measures MRSI-t study was to establish intra-subject reproducibility and repeatability of brain temperature, as well as typical brain temperature range.Methods: Healthy participants aged 23–46 years were scanned at two time points ~12-weeks apart. Volumetric MRSI data were processed by (...) reconstructing metabolite and water images using parametric spectral analysis. Brain temperature was derived using the frequency difference between water and creatine for 47 regions of interest delineated by the modified Automated Anatomical Labeling atlas. Reproducibility was measured using the coefficient of variation for repeated measures, and repeatability was determined using the standard error of measurement. For each region, the upper and lower bounds of Minimal Detectable Change were established to characterize the typical range of TCRE values.Results: The mean global brain temperature over all subjects was 37.2°C with spatial variations across ROIs. There was a significant main effect for time [F = 37.0, p < 0.0001] and for brain region [F = 2.66, p < 0.0001]. The time*brain region interaction was not significant [F = 0.80, p = 0.83]. Participants' TCRE was stable for each ROI across both time points, with ROIs' COVrep ranging from 0.81 to 3.08% ; majority of ROIs had a COVrep <2.0%.Conclusions: Brain temperature measurements were highly consistent between both time points, indicating high reproducibility and repeatability of MRSI-t. MRSI-t may be a promising diagnostic, prognostic, and therapeutic tool for non-invasively monitoring brain temperature changes in health and disease. However, further studies of healthy participants with larger sample size and numerous repeated acquisitions are imperative for establishing a reference range of typical brain TCRE, as well as the threshold above which TCRE is likely pathological. (shrink)

In the United Kingdom, a number of National Health Service Clinical Commissioning Groups have proposed controversial measures to restrict elective surgery for patients who either smoke or are obese. Whilst the nature of these measures varies between NHS authorities, typically, patients above a certain Body Mass Index and smokers are required to lose weight and quit smoking prior to being considered eligible for elective surgery. Patients will be supported and monitored throughout this mandatory period to ensure their clinical (...) needs are appropriately met. Controversy regarding such measures has primarily centred on the perceived unfairness of targeting certain health states and lifestyle choices to save public money. Concerns have also been raised in response to rhetoric from certain NHS authorities, which may be taken to imply that such measures punitively hold people responsible for behaviours affecting their health states, or simply for being in a particular health state. In this paper, we examine the various elective surgery rationing measures presented by NHS authorities. We argue that, where obesity and smoking have significant implications for elective surgical outcomes, bearing on effectiveness, the rationing of this surgery can be justified on prognostic grounds. It is permissible to aim to maximise the benefit provided by limited resources, especially for interventions that are not urgently required. However, we identify gaps in the empirical evidence needed to conclusively demonstrate these prognostic grounds, particularly for obese patients. Furthermore, we argue that appeals to personal responsibility, both in the prospective and retrospective sense, are insufficient in justifying this particular policy. Given the strength of an alternative justification grounded in clinical effectiveness, rhetoric from NHS authorities should avoid explicit statements, which suggest that personal responsibility is the key justificatory basis of proposed rationing measures. (shrink)

Lei, a twenty‐seven‐year‐old Mandarin speaker, visits the United States seeking curative treatments for his acute myeloid leukemia. His mother, Hua, has traveled with him. Neither she nor Lei speak English, and the hospital does not have an onsite professional Mandarin‐speaking interpreter. Using a professional interpreter over the phone, Lei's oncologist, Dr. Branson, attempts to initiate a face‐to‐face goals‐of‐care conversation with Hua as the surrogate decision‐maker. Dr. Branson explains that Lei has “only weeks to months to live” and recommends initiating comfort‐care‐only (...) measures, but Hua says that she wants (and that Lei would want) continued aggressive measures. Hua says that her son might be a candidate for a phase I trial. Eventually, Dr. Branson brings in Dr. Chou, a Mandarin‐speaking resident to provide face‐to‐face interpretation. Hua insists that “there must be more standard therapies available” and says that she will wait until the trial begins. She begins crying, and the meeting disintegrates. Following this, Dr. Branson calls for an ethics consultation for “help in end‐of‐life communicating and reconciling discordance about prognostic information.”How should the ethicist use the institution's interpreter services? (shrink)

Background We report a randomised controlled clinical trial of neurofeedback therapy intervention for ADHD/ADD in adults. We focus on internal mechanics of neurofeedback learning, to elucidate the primary role of cortical self-regulation in neurofeedback. We report initial results; more extensive analysis will follow. Methods Trial has two phases: intervention and follow-up. The intervention consisted of neurofeedback treatment, including intake and outtake measurements, using a waiting-list control group. Treatment involved $\sim$40 hour-long sessions 2-5 times per week. Training involved either theta/beta or (...) sensorimotor-rhythm regimes, adapted by adding a novel 'inverse-training' condition to promote self-regulation. Follow-up (ongoing) will consist of self-report and executive function tests. Setting Intake and outtake measurements were conducted at University of Helsinki. Treatment was administered at partner clinic Mental Capital Care, Helsinki. Randomisation We randomly allocated half the sample then adaptively allocated the remainder to minimise baseline differences in prognostic variables. Blinding Waiting-list control design meant trial was not blinded. Participants 54 adult Finnish participants (mean age 36 years; 29 females) were recruited after screening by psychiatric review. 44 had ADHD diagnoses, 10 had ADD. Measurements Symptoms were assessed by computerised attention test (T.O.V.A.) and self-report scales, at intake and outtake. Performance during neurofeedback trials was recorded. Results Participants were recruited and completed intake measurements during summer 2012, before assignment to treatment and control, September 2012. Outtake measurements ran April-August 2013. After dropouts, 23 treatment and 21 waiting-list participants remained for analysis. Initial analysis showed that, compared to waiting-list control, neurofeedback promoted improvement of self-reported ADHD symptoms, but did not show transfer of learning to T.O.V.A. Comprehensive analysis will be reported elsewhere. Trial Registration "Computer Enabled Neuroplasticity Treatment (CENT)", ISRCTN13915109. Partly funded by Finnish science agency TEKES, project #440078. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth (...) semistructured interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California (...) teaching hospitals from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue (...) psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs. (shrink)

Optic neuropathies are conditions that cause disease to the optic nerve, and can result in loss of visual acuity and/or visual field defects. An improved understanding of how these conditions affect the entire visual system is warranted, to better predict and/or restore the visual loss. In this article, we review visually-driven functional magnetic resonance imaging (fMRI) studies of optic neuropathies, including glaucoma and optic neuritis (ON); we also discuss traumatic optic neuropathy (TON). Optic neuropathy-related vision loss results in fMRI deficit (...) within the visual cortex, and is often strongly correlated with clinical severity measures. Using predominantly flickering checkerboard stimuli, glaucoma studies indicated retinotopic-specific cortical alteration with more prominent deficits in advanced than in early glaucoma. Some glaucoma studies indicate a reorganized visual cortex. ON studies have indicated that the impacted cortical areas are briefly hyperactive. For ON, brain deficits are greater in the acute stages of the disease, followed by (near) normalization of responses of the LGN, visual cortex, and the dorsal visual stream, but not the ventral extrastriate cortex. Visually-driven fMRI is sensitive, at least in ON, in discriminating patients from controls, as well as the affected eye from the fellow eye within patients. The use of a greater variety of stimuli beyond checkerboards (e.g., visual motion and object recognition) in recent ON studies is encouraging, and needs to continue to disentangle the results in terms of change over time. Finally, visually-driven fMRI has not yet been applied in TON, although preliminary efforts suggest it may be feasible. Future fMRI studies of optic neuropathies should consider using more complex visual stimuli, and inter-regional analysis methods including functional connectivity. We suggest that a more systematic longitudinal comparison of optic neuropathies with advanced fMRI would provide improved diagnostic and prognostic information. (shrink)

Machine‐learning algorithms have the potential to revolutionise diagnostic and prognostic tasks in health care, yet algorithmic performance levels can be materially worse for subgroups that have been underrepresented in algorithmic training data. Given this epistemic deficit, the inclusion of underrepresented groups in algorithmic processes can result in harm. Yet delaying the deployment of algorithmic systems until more equitable results can be achieved would avoidably and foreseeably lead to a significant number of unnecessary deaths in well‐represented populations. Faced with this (...) dilemma between equity and utility, we draw on two case studies involving breast cancer and melanoma to argue for the selective deployment of diagnostic and prognostic tools for some well‐represented groups, even if this results in the temporary exclusion of underrepresented patients from algorithmic approaches. We argue that this approach is justifiable when the inclusion of underrepresented patients would cause them to be harmed. While the context of historic injustice poses a considerable challenge for the ethical acceptability of selective algorithmic deployment strategies, we argue that, at least for the case studies addressed in this article, the issue of historic injustice is better addressed through nonalgorithmic measures, including being transparent with patients about the nature of the current epistemic deficits, providing additional services to algorithmically excluded populations, and through urgent commitments to gather additional algorithmic training data from excluded populations, paving the way for universal algorithmic deployment that is accurate for all patient groups. These commitments should be supported by regulation and, where necessary, government funding to ensure that any delays for excluded groups are kept to the minimum. We offer an ethical algorithm for algorithms—showing when to ethically delay, expedite, or selectively deploy algorithmic systems in healthcare settings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Literature 27.1 (2003) 40-61 [Access article in PDF] Montaigne, Skepticism and Immortality Zahi Zallou I IN THE LAST PAGES OF HIS ESSAY "Of Experience," Michel de Montaigne warns against the desire to "go outside ourselves." 1 While Montaigne apparently spares Christian mystics from his biting critique ("those venerable souls, exalted by ardent piety and religion to constant and conscientious meditation on divine things" [p. 856]), there is (...) no suggested criterion enabling one to discriminate between these "venerable souls" and those individuals dangerously engaging in similar practices, claiming to have similar mystical religious experiences. The latters' "care of the self" (cura sui) is a kind of caring that would paradoxically do violence to their human self (conceived by Montaigne as both mind and body): "That is madness: instead of changing into angels [in order to be closer to the divinitas of God], they change into beasts [a regression to the realm of animalitas]; instead of raising themselves, they lower themselves" (p. 856). With this conduplicatio, the repetition of the verb "to change," Montaigne emphasizes the role of agency, thus pointing out that they are to a large measure responsible for their condition, through their practices of self-care, or rather what Nietzsche has called their spiritual "incuria sui." 2 Neither the mind nor the body should be excluded from serious consideration, Montaigne stresses: "For it is indeed reasonable, as they say, that the body should not follow its appetites to the disadvantage of the mind; but why is it not also reasonable that the mind should not pursue its appetites to the disadvantage of the body?" (p. 681). Divorcing the mind from the body is, indeed, seen as an unwise, and potentially disastrous, practice: [End Page 40] Those who want to split up our two principal parts and sequester them from each other are wrong. (p. 484) To what purpose do we dismember by force a structure made up of such close and brotherly correspondence? On the contrary, let us bind it together again by mutual services. Let the mind arouse and quicken the heaviness of the body, and the body check and make fast the lightness of the mind. (p. 855) Montaigne's suspicion of claims pertaining to the transcendent realm is perhaps most forcefully expressed in his late additions to "Of Experience": "Between ourselves, these are two things that I have always observed to be in singular accord: supercelestial thoughts and subterranean conduct. [...] These transcendental humors frighten me, like lofty and inaccessible places" (p. 856). Not even Socrates, who is known to have engaged in excessive spiritual meditations, is spared from the essayist's critical reflections: "And nothing is so hard for me to stomach in the life of Socrates as his ecstasies and possessions by his daemon, nothing is so human in Plato as the qualities for which they say he is called divine" (p. 856). This should be seen as a qualification of his earlier discussion of Socrates's daimonion in "Of Prognostications": "The daemon of Socrates was perhaps a certain impulse of the will that came to him without awaiting the advice of his reason [discours]. In a well-purified soul such as his, prepared by a continual exercise of wisdom and virtue, it is likely that these inclinations, although instinctive and undigested, were always important and worth following" (pp. 29-30). What is at issue here is the contrast (yet without any tension) between reason's way and God's way, so to speak, between Socrates's "discours" (his reason, which dictates to him the appropriate and rational means of action) and his "demon" (Socrates's divine voice or "divine sign," 3 which informs him of what to do and, especially, not to do). 4 Due to Socrates's wise and virtuous character, the essayist speculates, the former never erred in acting on his impulses or undigested inclinations. Montaigne generalizes and is even tempted to translate some of his own past actions in terms of a Socratic-like divine inspiration: "Everyone feels within himself some likeness of such stirrings [...] And I have had some [...] by which I let myself... (shrink)

Objectives: The objective of this study is to investigate the relationship between a physician’s subjective mortality prediction and the level of confidence with which that mortality prediction is made.Design and participants: The study is a prospective cohort of patients less than 18 years of age admitted to a tertiary Paediatric Intensive Care Unit at a University Children’s Hospital with a minimum length of ICU stay of 10 h. Paediatric ICU attending physicians and fellows provided mortality risk predictions and the level (...) of confidence associated with these predictions on consecutive patients at the time of multidisciplinary rounds within 24 hours of admission to the paediatric ICU. Median confidence levels were compared across different ranges of mortality risk predictions.Results: Data were collected on 642 of 713 eligible patients . Mortality predictions greater than 5% and less than 95% were made with significantly less confidence than those predictions 95%. Experience was associated with greater confidence in prognostication.Conclusions: We conclude that a physician’s subjective mortality prediction may be dependent on the level of confidence in the prognosis; that is, a physician less confident in his or her prognosis is more likely to state an intermediate survival prediction. Measuring the level of confidence associated with mortality risk predictions may therefore be important because different levels of confidence may translate into differences in a physician’s therapeutic plans and their assessment of the patient’s future. (shrink)

Unilateral spatial neglect is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality systems in combination with eye-tracking have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive (...) and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person’s needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs. (shrink)

There is no broad dispute in the doctrine on the matter how and on what purpose did the drugs appear in the nature and in the society. Why does a certain spectrum of light and sound waves and electromagnetic radiations bring a person into a state of euphoria? The Author has united biological and chemical substances as well as the sources of other origin changing person’s consciousness into a joint hypersystem: narcogenes’ movement recorded in the past,observable in the present and (...) expected in the future. It is admissible to associate the sources of formation of the modern variety of narcogens with the origin of life by means of «the reasonable plan», «lucky coincidence», panspermia in their interaction or otherwise. The life distribution on the Earth during 3.5 billion years with the participation of narcogenes has caused such global phenomena as drug trafficking and narcomania (toxicomania). Today narcogenes are discovered in all earthly environments and the vector of theirmovement is directed by a man beyond the limits of the earthly surface. In a set of regular medicines they are placed onboard tens thousands flight vehicles, shuttles and ISS are supplied with them. In 1969 onboard «Apollo-11» narcogens were first delivered to an orbitof the Moon. The happenings of their «exterrestia» consumption on the circumterrestrial orbit have already been recorded. Onward are narcogenic mixers, nanorobots, transferring narcogenes in a human’s brain and so forth. The postglobal scope of the narcogenes’ movement may get a colossal swing as the people develop the deep space, build circumplanetary settlements (upward 10 thousand people) and planetary colonies. It is time that the scientists payattention to the prognostic side of the problem under consideration and develop preemptive measures. (shrink)

There is no broad dispute in the doctrine on the matter how and on what purpose did the drugs appear in the nature and in the society. Why does a certain spectrum of light and sound waves and electromagnetic radiations bring a person into a state of euphoria? The Author has united biological and chemical substances as well as the sources of other origin changing person’s consciousness into a joint hypersystem: narcogenes’ movement recorded in the past,observable in the present and (...) expected in the future. It is admissible to associate the sources of formation of the modern variety of narcogens with the origin of life by means of «the reasonable plan», «lucky coincidence», panspermia in their interaction or otherwise. The life distribution on the Earth during 3.5 billion years with the participation of narcogenes has caused such global phenomena as drug trafficking and narcomania (toxicomania). Today narcogenes are discovered in all earthly environments and the vector of theirmovement is directed by a man beyond the limits of the earthly surface. In a set of regular medicines they are placed onboard tens thousands flight vehicles, shuttles and ISS are supplied with them. In 1969 onboard «Apollo-11» narcogens were first delivered to an orbitof the Moon. The happenings of their «exterrestia» consumption on the circumterrestrial orbit have already been recorded. Onward are narcogenic mixers, nanorobots, transferring narcogenes in a human’s brain and so forth. The postglobal scope of the narcogenes’ movement may get a colossal swing as the people develop the deep space, build circumplanetary settlements (upward 10 thousand people) and planetary colonies. It is time that the scientists payattention to the prognostic side of the problem under consideration and develop preemptive measures. (shrink)

Biomarkers are widely used not only as prognostic or diagnostic indicators, or as surrogate markers of disease in clinical trials, but also to formulate theories of pathogenesis. We identify two problems in the use of biomarkers in mechanistic studies. The first problem arises in the case of multifactorial diseases, where different combinations of multiple causes result in patient heterogeneity. The second problem arises when a pathogenic mediator is difficult to measure. This is the case of the oxidative stress (OS) (...) theory of disease, where the causal components are reactive oxygen species (ROS) that have very short half-lives. In this case, it is usual to measure the traces left by the reaction of ROS with biological molecules, rather than the ROS themselves. Borrowing from the philosophical theories of signs, we look at the different facets of biomarkers and discuss their different value and meaning in multifactorial diseases and system medicine to inform their use in patient stratification in personalized medicine. (shrink)

Objective: We hypothesized that the reasons behind this tension are complex and can be understood better by applying social psychology theory.Design: A qualitative methodology was drawn on for data collection and thematic analysis, with focus group discussions adopted for interviews with patient families and ICU physicians. Additionally, we used a social psychology theory, the reasoned action approach (RAA) framework, to understand these tensions.Setting: Two 15-bedded ICUs of an academic university–affiliated teaching hospital in Singapore.Subjects: A total of 72 physicians and family (...) members of older ICU patients (>70 years old).Measurements and Main Results: The primary analysis revealed five areas of tension around prognostication in the ICU. These dealt with issues of divergent views, different role expectations, conflicting emotional responses, and issues of communication and trust. Further analysis helped to identify underlying factors leading to tensions and behaviors. Differences in prognostication and in expectation of outcomes between clinicians and family members were the main cause of tensions. When the RAA framework was applied, these tensions could be predicted early on and understood more clearly.Conclusions: Tensions revolve around losing control of the patient’s care, differences between hopeful expectations and clinical prognostication, perceived biases of physicians, and underlying mistrust between families and physicians. (shrink)

The possibility of early diagnosis and intervention is radically changed by the advent of genetic testing. The recent report of the Nuffield Council on Bioethics is timely and helpful. I have suggested, that not only the severity of the disability indicated by genetic information, and the accuracy of the data, ought to govern the approach to the implementation of screening for genetic disorders. In addition, assessment of the value of the information to those involved should be considered. The efficacy of (...) the available therapeutic measures, combined with the prognostic data are important indices of the value of the information. These measures fall into three categories and thus indicate that three different courses of intervention may be appropriate. Three approaches to diagnosis and intervention are then outlined, drawing on the experience of various clinical initiatives. (shrink)

This paper examines the role existence plays in measurement validity. I argue that existing popular theories of measurement and of validity follow a correspondence framework, which starts by assuming that an entity exists in the real world with certain properties that allow it to be measurable. Drawing on literature from the sociology of measurement, I show that the correspondence framework faces several theoretical and practical challenges. I suggested the validity-first framework of measurement, which starts with a practice-based validation process as (...) the basis for a measurement theory, and only posits objective existence when it is scientifically useful to do so. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and (...) chi2-tests for dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

An adolescent’s last moment of life is an emotionally and medically complex time. Children may grapple with understanding the things happening to them and with grief of a future lost; caregivers struggle to simultaneously balance deep sorrow, hope, and love; and healthcare providers fight to maintain sound medical and ethical decision making. Increased discussion regarding adolescent end-of-life care is needed so that clinicians may better understand how to engage in ethically based medical management during these events. This holds particularly true (...) in situations where potentially conflicting ideas exist between clinicians and family members. We describe the case of an acutely and terminally ill adolescent who remained cognitively intact but with rapidly advancing multiple organ failure and whose parents requested that he remain uninformed of his critical illness and prognosis. (shrink)

Previous studies have found Forsyth’s Ethical Position Questionnaire (EPQ) to vary between countries, but none has made a systematic evaluation of its psychometric properties across consumers from many countries. Using confirmatory factor analysis and multi-group LISREL analysis, this paper explores the factor structure of the EPQ and the measurement equivalence in five societies: Austria, Britain, Brunei, Hong Kong and USA. The results suggest that the modified scale, measuring idealism and relativism, was applicable in all five societies. Equivalence was found across (...) Britain, Brunei and USA, but the original scale cannot be used validly. (shrink)

On the basis of careful textual exegesis and philosophical analysis, and contrary to the received view, Mark R. Wheeler demonstrates that Aristotle presents and systematically explicates his definition of the essence of the truth in the Metaphysics. Aristotle states the nominal definitions of the terms "truth" and "falsehood" as part of his arguments in defense of the logical axioms. These nominal definitions express conceptions of truth and falsehood his philosophical opponents would have recognized and accepted in the context of dialectical (...) argument. On the basis of these nominal definitions, Aristotle develops his definitions of the essences of truth and falsehood--his "real" definitions of truth and falsehood. Aristotle's methodical exposition of his essential definitions of truth and falsehood in the Metaphysics serves as a well-developed example of how his philosophical inquiry starts with nominal definitions and ends with real definitions. Wheeler also argues for the novel claim that Aristotle defines the most fundamental kind of truth in terms of accurate measurement. Aristotle's metrical conception of truth serves as the theoretical basis for specifying the truth conditions of various assertions, for identifying the sorts of beings implicated in these truth conditions, and for explaining the nature of approximate truth and falsehood. Far from offering us a minimal account of truth, Wheeler shows how Aristotle offers us a sophisticated and metrical theory of truth. (shrink)

Purpose. The aim of the article is to clarify the content of the concept of culture as an explication of vitality within the philosophy of life and its further modifications in current problems of contemporary. The analysis performed standing from the point, that contrasting of nature and culture is irrelevant, since culture does not contradict natural determinants and patterns, but rather qualitatively alters them. So, are justified the idea of culture as a phenomenon that exist accordingly and in proportion to (...) nature, need to form its potential and content and not contradict the axioms and values of life. Theoretical basis. In the theoretical field of philosophy of life, the local development of the problem of culture as an explication of vitality produces grounds for analytical and prognostic activity concerning meaningful transformations in a separate historical and social horizon. The fundamental categories of culture: spirit, value, symbol, freedom, justice and harmony receive the requested content and meaning. The idea of the constancy and super-naturality of cultural universals is illusory and dangerous. The consequences of such a "non-cosmological" justification of freedom and will, and the assertion of values, that contradict the logic of life, are the global environmental, economic and social crisis of our time. Originality. The originality of the authors’ thought lies in the interpretation of the essence of culture as an explication of vitality, as a logical and natural extension of life. In this formulation of the problem of culture, the possibility of reconciling the natural, social and value determinants of human life is formed. Theorists of the philosophy of life substantiated the primacy and supremacy of the values of life over the values and meanings of culture. The position of authors position consists in the need to understand culture as an environmentally appropriate and dimensional phenomenon, the content and strategies of which are determined by a single ontology. Conclusions. The analysis let authors understand the voluntarily chaotic element of life. Culture in its philosophical analysis took on a clearer anthropomorphic dimension: the immanent logic of being in substantiating the essence and purpose of man and the value of his being localized the universe of transcendence in the concept of "living world", "inhabited space", "human, too human". Accordingly, the range of cultural evaluations has been polarized: from the approving statement of its vital essence, to the disparaging calls for its reform. The chaotic state of voluntarily acts is transformed into cultural codes and stereotypes by rationalization. The modern global nature of crisis phenomena, both in the worldview, in the social, and in the ecological dimension, requires reformatting the understanding of culture as a continuation of nature, and not its antipode. (shrink)

Negative prognostic communication is often delayed in intensive care units, which limits time for families to prepare for end‐of‐life. This descriptive study, informed by ethnographic methods, was focused on exploring critical care physician communication of negative prognoses to families and identifying timing influences. Prognostic communication of critical care physicians to nurses and family members was observed and physicians and family members were interviewed. Physician perception of prognostic certainty, based on an accumulation of empirical data, and the perceived (...) need for decision‐making, drove the timing of prognostic communication, rather than family needs. Although prognoses were initially identified using intuitive knowledge for patients in one of the six identified prognostic categories, utilizing decision‐making to drive prognostic communication resulted in delayed prognostic communication to families until end‐of‐life (EOL) decisions could be justified with empirical data. Providers will better meet the needs of families who desire earlier prognostic information by separating prognostic communication from decision‐making and communicating the possibility of a poor prognosis based on intuitive knowledge, while acknowledging the uncertainty inherent in prognostication. This sets the stage for later prognostic discussions focused on EOL decisions, including limiting or withdrawing treatment, which can be timed when empirical data substantiate intuitive prognoses. This allows additional time for families to anticipate and prepare for end‐of‐life decision‐making. (shrink)

Background: Cognitive Training may contribute to the maintenance and even enhancement of cognitive functions in healthy older adults. However, the question who benefits most from multi-domain CTs is still highly under-investigated.Objective: The goal is to investigate prognostic factors and models for changes in cognitive test performance in healthy older adults after a multi-domain CT.Methods: The data bases MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to July 2019. Studies investigating prognostic factors and/or models on (...) cognitive outcomes after conducting a multi-domain CT in healthy older adults were included. Risk of Bias was assessed using the QUIPS and the PROBAST tool.Results: 23 prognostic factor and model studies were included. Results indicate a high heterogeneity regarding the conducted multi-domain CTs, the investigated prognostic factors, the investigated outcomes, and the used statistical approaches. Age and neuropsychological performance at study entry were the most investigated predictors, yet they show inconsistent results.Conclusion: Data on prognostic factors and models of changes after multi-domain CT are still too rare and inconsistent to draw clear conclusions due to statistical shortcomings and low reporting quality. Approaches for future research are outlined.Registration:https://www.crd.york.ac.uk/prospero/, ID: CRD42020147531. (shrink)

This article concerns the distinction between memory-time and information-time, which appeared in Wittgenstein’s middle-period lectures and writings, and its relation to Wittgenstein’s career-long reflection about musical understanding. While the idea of “information-time” entails a public frame of reference typically pertaining to objects which persist in physical time, the idea of pure “memory-time” involves the totality of one’s present memories and expectations that do now provide any way of measuring time-spans. I argue that Wittgenstein’s critique of Augustine notion of pure memory-time (...) entails ipso facto a critique of an influential idea of musical motion, which has been recurring in the work of some major philosophers of music up until the present day. The article connects Wittgenstein’s critical remarks on the confused foundations of such “Augustinian Picture of Music” with his emphasis on the notion of phrasing or characterization in language and music. Wittgenstein’s reversal of Augustinian priorities regarding musical time brings to surface the particularity of expression and the aesthetically “right” in music, evoked by Wittgenstein’s remarks on simultaneity and tempo in music and language. Wittgenstein renders musical simultaneity as enabled by a “protocol” which inheres in musizieren, in the aptly collaborative quest for drawing in significance by means of the phrasing and re-phrasing of a passage in order to characterize it, enabling by means of such comparative investigation meaningful distinctions between right and wrong. (shrink)

As societies become increasingly technologised, the need for careful and critical assessment rises. However, attempts to assess or normatively evaluate technological development invariably meet with an antinomy: both structurally and historically, technologies display multistable possibilities regarding uses, effects, side effects and other outcomes. Philosophers, usually expected to play applied ethics roles, often come to the scene after these effects are known. But others who participate at the research and development stages find even more difficulties with prognosis. Recent work on ‘revenge’ (...) effects (Tenner) and negative side effects (Kevles) are examined, as well as several cases of philosophers in ‘R&D’ roles. After sketching the antinomy,I outline a heuristic pragmatics of prognosis that addresses this quandary. (shrink)

In the United States, at least 6% of all hospital beds are in the intensive care unit or coronary care unit. The cost of treating a patient in an intensive care unit averages from $2,000 to $3,500 per day. At least 10–40% of intensive care patients will not survive to hospital discharge. Today, every major category of disease may be found in the modern ICU; common diagnoses are septicemia, postsurgical complications, cerebrovascular accidents, gastrointestinal bleeding, neoplasia, and respiratory failure. ICUs employ (...) some of the most sophisticated medical technology, routinely monitoring the cardiopulmonary performance of patients and often providing assisted ventilation. ICUs are high intensity in terms of their staffing, involving 24-hour physician supervision and nurse:patient ratios from 1:3 to 1:1. (shrink)

I offer a reconstruction of contemporary medical procedures of sex assignment for infants with intersex conditions. In the perspective adopted, sex assignment to intersexed newborns can be understood as a procedure that imposes determinate sex predicates. The account describes two stages of sex assignment. At the first stage of the process, the sex predicates ‘female’, ‘male’, or ‘intersexed’ are taken to denote genital morphology. Initial genital assessment of newborns imposes clear boundaries upon the extensions of these predicates through diagnostic schemes (...) of precisification. At the second stage, the sex predicates ‘female’ and ‘male’ denote sex of rearing, a therapeutic and pedagogical project aimed at producing stable and psycho-socially well-adjusted gender identity. The multi-dimensional indeterminacy of prognosticating sex of rearing at the second stage is mitigated through the prioritization of some subsets of the medical data. (shrink)

The need for quantitative measurement represents a unifying bond that links all the physical, biological, and social sciences. Measurements of such disparate phenomena as subatomic masses, uncertainty, information, and human values share common features whose explication is central to the achievement of foundational work in any particular mathematical science as well as for the development of a coherent philosophy of science. This book presents a theory of measurement, one that is "abstract" in that it is concerned with highly general axiomatizations (...) of empirical and qualitative settings and how these can be represented quantitatively. It was inspired by, and represents a generalization and extension of, the last major research work in this field, Foundations of Measurement Vol. I, by Krantz, Luce, Suppes, and Tversky published in 1971. (shrink)