The relationship between urban expansion and population density changes is complex and plays a fundamental role in urban sustainable development research. This relationship has been studied in multiple large cities. However, there is no report of the relationship of the two factors mentioned above in urban agglomeration in a particular region of China. Ten cities located in the central-southern region of Liaoning province are selected as research samples in this study. The spatial growth rate and (...) class='Hi'>urban compactness index of the sample cities were calculated using the land use and population data of these cities in three time phases: 1995, 2005, and 2015. Then, the geographical growth features, the population density changes, and the link between these two in the sample cities were investigated at these three periods. Our results revealed that the studied cities of central-southern Liaoning province expanded at the three time phases under the driver of positive population density growth, but the effects of urban population change on urbanization growth modes across time were uneven across different periods. Our study showed a trend that active transition of different urbanization growth modes was associated with decreased population density. (shrink)

Children who live on the margins of society are disadvantaged in achieving their developmental potential because of the lack of a necessary stable environment and nurturing care. Many early prevention programs aim at mitigating such effects, but often the evaluation of their long-term effect is missing. The aim of the study presented here was to evaluate such long-term effects in two prevention programs for children-at-risk growing up in deprived social environments focusing on child attachment representation as the primary outcome as (...) well as on self-reflective capacities of teachers taking care of these children. The latter was a key component for promoting resilient behavior in children. Five hundred and twenty-six children aged 36 to 60 months at risk due to immigration status, low family socio-economic status and child behavior were examined in a cluster-randomized study comparing two preventions, the psychodynamic, attachment-based holistic approach EARLY STEPS (ES) with the classroom based FAUSTLOS (FA) for their efficacy. Primary outcome was the child attachment representation measured by the Manchester Child Attachment Story Task (MCAST). Secondary outcomes were derived from (a) the Caregiver-Teacher Report Form (C-TRF: problem behaviors, including anxiety/depressive symptoms, emotional-reactive and somatic problems, social withdrawal, aggressive behavior, and attention deficit), from (b) the Strength and Difficulties Questionnaire (SDQ, parent version: resilience and wellbeing) and (c) Self-Reflective Scales for teachers (SRS: self-reflective capacities of teachers). Compared to baseline, attachment and behavioral problems improved in both programs. ES led to more secure and more organized attachment representations (medium effect sizes). Aggressive behavior and externalizing problems were reduced in the FA group compared with ES, particularly in boys (medium effect sizes). Self-reflective capacities of the teachers increased only in the ES group. High correlation between children’s attachment type with the number of social risk factors and the increase of problematic social behavior strongly indicate that an increase in teachers’ self-reflective capacities helps to change children’s attachment patterns which thus strengthens the resilience of these children-at-risk [An ethical vote from LPPKJP 2009-02-25 was obtained and the trial registered; Clinical trial registration information: The trial was registered 14.02.2012 (DRKS00003500;https://www.drks.de)]. (shrink)

Cities and towns are expanding and thriving as a result of urbanization, which also significantly changes the local climate. One of the most significant phenomena associated with urbanization is the Urban Heat Island (UHI) effect. This phenomenon is increasingly being studied worldwide. The paper aims to investigate the UHI phenomenon in the metropolitan area of Tirana, Albania. It analyses the impact of the UHI on four specific locations in Tirana, its causes and mitigation measures, as well as variations in (...) surface temperature, CO2 emissions, and relative humidity. The regions are measured and observed using a specific instrument such as the Testo 435. Considering the mean surface temperature variations between urban and rural regions ranging from 28.4°C to 33.7 °C, CO2 emissions from 302.9 ppm to 416.2 ppm, and relative humidity from 34.1% to 41.2%, it is found that the UHI impact in Tirana is significant. The lack of green spaces, high building density, urban patterns, building materials used, transport, and energy use are the main contributors to the UHI in central Tirana. Increasing green spaces, using reflective materials, and promoting sustainable urban design are some of the mitigation techniques suggested to reduce the UHI effect in Tirana. (shrink)

For achieving the sustainable development goals, green development has been raised to a high position for cities in China. The economic development in Northwest China is slow, the ecological environment is fragile, and the mineral resources are rich. Only through green development can we realize the comprehensive income of regional production development, rich life, and good ecology. This paper measures the green development efficiency of 30 prefecture-level cities in Northwest China by using DEA-SBM model of unexpected output, explores the differences (...) and causes of green development efficiency from the perspective of time and space through convergence coefficient, coordination matrix, GIS, and other methods, and empirically tests the impact of industrial structure, technological progress, and other driving factors on green development efficiency by using panel Tobit model. The results show that, on the whole, the efficiency of green development in Northwest China is low, path dependence is serious and unbalanced, the coordinated development effect of different regions is weak, and the spillover effect of core urban agglomerations has not been effectively exerted; from the perspective of driving factors, economic development, population density, traffic situation, and education investment can significantly improve the efficiency of urban green development, and the second is that the proportion of industries significantly hinders the improvement of green development efficiency, while the impact of scientific and technological innovation is not significant. Based on the empirical results, this paper believes that the harmonious development of natural environment and economic society can be realized only by improving the coordinated development effect among cities, implementing the optimization and upgrading of industrial structure, introducing excellent talents, and promoting the technological upgrading. (shrink)

Many factors complicate the education of urban students. Among them have been issues related to population density; racial, ethnic, cultural, and linguistic diversity; poverty; racism ; and funding levels. Although urban educators have been addressing these issues for decades, placing them under the umbrella of "urban education" and treating them as a specific area of practice and inquiry is relatively recent. Despite the wide adoption of the term a consensus about its meaning exists at only the (...) broadest of levels. In short, urban education remains an ill-defined concept. This comprehensive volume addresses this definitional challenge and provides a 3-part conceptual model in which the achievement of equity for all -- regardless of race, gender, or ethnicity – is an ideal that is central to urban education. The model also posits that effective urban education requires attention to the three central issues that confronts all education systems _accountability_ of individuals and the institutions in which they work, _leadership_, which occurs in multiple ways and at multiple levels, and _learning_, which is the raison d'être of education. Just as a three-legged stool would fall if any one leg were weak or missing, each of these areas is essential to effective urban education and affects the others. (shrink)

The venerable cities of the past, such as Venice or Amsterdam, convey a feeling of wholeness, an organic unity that surfaces in every detail, large and small, in restaurants, shops, public gardens, even in balconies and ornaments. But this sense of wholeness is lacking in modern urban design, with architects absorbed in problems of individual structures, and city planners preoccupied with local ordinances, it is almost impossible to achieve. In this groundbreaking volume, architect and planner Christopher Alexander presents a (...) new theory of urban design which attempts to recapture the process by which cities develop organically. To discover the kinds of laws needed to create a growing whole in a city, Alexander proposes here a preliminary set of seven rules which embody the process at a practical level and which are consistent with the day-to-day demands of urban development. He then puts these rules to the test, setting out with a number of his graduate students to simulate the urban redesign of a high-density part of San Francisco, initiating a project that encompassed some ninety different design problems, including warehouses, hotels, fishing piers, a music hall, and a public square. This extensive experiment is documented project by project, with detailed discussion of how each project satisfied the seven rules, accompanied by floorplans, elevations, street grids, axonometric diagrams and photographs of the scaled-down model which clearly illustrate the discussion. A New Theory of Urban Design provides an entirely new theoretical framework for the discussion of urban problems, one that goes far to remedy the defects which cities have today. (shrink)

The micro blogging platform Twitter is actively used by millions of people. By using the geo tags of the messages sent a virtual landscape of online activity at a certain place is generated to visualize the interface between the real-world location and the virtual activity. These New City Landscapes (NCL) visualize the amount of activity as density surfaces with hills, peaks and valleys. Across a set of different cities from around the world the resulting landscape morphologies are compared and (...) characterized as types. This article focuses on temporal narratives and how they travel through the urban fabric via the virtual landscape in different cities around the world. The findings are discussed as cross comparisons according to activity in time and space. (shrink)

In this paper, I explore connections between two disciplines not typically linked: argumentation theory and urban design. I first trace historical ties between the art of reasoned discourse and the idea of civic virtue. I next analyze discourse norms implicit in three theories of urban design: Jane Jacobs' The Death and Life of Great American Cities (1961), Christopher Alexander's A Pattern Language: Towns, Buildings, Construction (1977), and Peter Katz's The New Urbanism: Toward an Architecture of Community (1994). I (...) then propose a set of ‘settlement’ issues of potential interest to both urban designers and argumentation theorists: size, density, heterogeneity, publicity, security, and identity. I conclude by suggesting that the ‘good city’ be seen as both a spatial and a discursive entity. From such a perspective, good public discourse is dependent, at least in part, on good public space; and good public space is defined, at least in part, as a context conducive to good public discourse. (shrink)

The emergence of urban tech economies calls attention to the multidimensional spatiality of ecosystems made up of people and organizations that produce new digital technology. Since the economic crisis of 2008, city governments have aggressively pursued economic growth by nurturing these ecosystems. Elected officials create public-private-nonprofit partnerships to build an “innovation complex” of discursive, organizational, and geographical spaces; they aim not only to jump-start economic growth but to remake the city for a new modernity. But it is difficult to (...) insert tech production space into the complicated urban matrix. Embedded industries and social communities want protection from expanding tech companies and the real estate developers who build for them. City council members, state legislators, and community organizations oppose the city government’s attempts to satisfy Big Tech companies. While the city’s density magnifies conflicts of interest over land-use and labor issues, the covid-19 pandemic raises serious questions about the city’s ability to both oppose Big Tech and keep creating tech jobs. (shrink)

Understandings of urban foodways in Zimbabwe and other African countries have been dominated by food security frameworks. The focus on material scarcity and measurable health outcomes within these frameworks has often obscured the socio-cultural dimension of foodways and the historical and political structures that have shaped, and continue to shape, everyday relationships with food among different groups of urban residents in cities. Addressing these often-overlooked aspects, this paper looks at intergenerational contestations over foodways in a midsized high-density (...) Zimbabwean town. Presenting results of 6-months ethnographic fieldwork involving participant observation and semi-structured interviews, the paper explores meanings and practices of food in a postcolonial urban setting using three generational groups as a point of departure. These groups are youth (aged 15 to 25 years old), a post-independence generation (aged 26 to 43) and a pre-independence middle-aged generation (aged 43 to 65). Findings show that foodways of the three generations, each having experienced Zimbabwe’s (post-)colonial political economy in different ways, are negotiated through postcolonial socio-ecological relations, urban–rural connections and social hierarchies articulated through urban and rural space. The paper concludes that to understand urban food security in a postcolonial setting, urbanites’ generation-specific life experiences and intergenerational negotiations around historically situated spatial and socio-ecological relations should be considered. The findings could inform urban food security policy to make it more targeted towards the needs of different generational groups as well as more attuned to urbanites’ dynamic socio-cultural foodways and the socio-ecological relations that shape these. (shrink)

Access to urban green space is associated with the enhancement of health and disparities in access generate issues of spatial equity and socioenvironmental justice. The aim of this study is to measure spatial accessibility and investigate access disparities to UGSs in urban areas of Harbin, China. A Gaussian-based two-step floating catchment area method and spatial autocorrelation analysis were used to measure the accessibility and evaluate its distribution patterns in residential tracts. Bivariate correlation was employed to examine the statistical (...) relations between demographic characteristics of residential tracts and green space access. The results show that most residential tracts have minimal green space access within walking distance, while a few have limited access within cycling distance. Additionally, spatial disparities were found with low-accessibility tracts clustering in the center of the city, while high-accessibility tracts were located in northern and southern suburbs. Demographic disparities were also identified in the study: females have less access to UGS than males, areas with a high birth rate generally have more access, and population density is negatively associated with UGS access. The findings not only indicate that Harbin has an uneven distribution and disproportionate provision of UGS for urban residents but also identify which areas and population groups within the city are disadvantaged in access to UGS and thus provide suggestions for future construction and provision of UGS. (shrink)

Knowledge of the patterns of location of retail stores in urban areas supports the development of effective urban planning and the reasonable allocation of commercial facilities. Using point of interest data and consumer survey data in three main commercial districts in Changchun, China, this study investigates the spatial structures of commercial districts and the patterns of distribution of retail stores to assess the determinants of the development of retail stores in commercial districts. Kernel density estimation, nearest neighbor (...) index, and Pearson’s correlation analysis were used for this study. The following conclusions are drawn. The spatial distribution of retail stores in Changchun commercial districts generates the coexistence of a concentration in the core area and diffusion in the peripheral area. The emergence of shopping malls has challenged the traditional single-center structure, resulting in the transformation of commercial districts from single-center to multicenter layouts, while also producing a hierarchical trend in development. The Chongqing Road and Hongqi Street commercial districts have a relatively high spatial concentration of retail stores. Retail stores in Guilin Road exhibit distinct characteristics, namely, stores selling textiles, clothing, and daily necessities show the highest concentration, and food, beverage, and tobacco outlets as well as integrated stores show the lowest concentration. The selected locations of the differing categories of stores on Chongqing Road strongly correlate, and textile, clothing, and daily necessity stores show a high correlation with other retail categories. Four main factors affect the development and spatial layout of retail in the commercial districts. First, the interaction between consumer behavior and location choice in retail stores promotes the evolution of retail formats and trends in the development of comprehensive, specialized, and hierarchical retail commercial spaces. Second, the retail format determines the spatial layouts and the historical inheritance of the format. Third, governmental planning and policies lead to the agglomeration and diffusion of commercial activities in different areas. Fourth, such spatial clustering effects are an external driving factor for integration and aggregation among retail formats. (shrink)

Previous research studies of traffic networks are mainly based on planar networks and less considered the influence of multilayer networks, which illustrate and represent different appropriate urban traffic modes. Development of rail and road networks is inseparable from the development of a prosperous urban area; thus, research on multilayer networks has scientific potential and fulfils a real need. In this paper, a framework of complex network based integrated multilayer urban growth and optimisation model is proposed, to analyse (...) the complex relationships between the traffic network structure, the population growth, and the urban land-use. The innovation of this paper is the combination of the traffic complex multilayer networks and the “Four Step Model”. With the multiobjective, multilayer network coevolution and optimisation model, a more efficient traffic network layout was generated based on different land-use, population density, and travel speed scenarios. Then, this paper has proved that the proposed CNIMUGOM can save the traffic network construction investment, reduce the travel cost, make the urban traffic network more efficient, and decrease the total traffic flow amount. This research has connected the recent complex multilayer network related study and traditional urban economic model based study. The findings of the study afford to improve the current land-use and traffic integrated models and can provide traffic network planning suggestions for urban agglomeration development. (shrink)

Considering the importance of China’s digital economy, industrial Internet, and high-quality development, this study analyzed China’s urban network from the perspective of the communications technology service industry. Three sub-networks and a comprehensive network were constructed. The density, centrality, and cohesive subgroups of the above network were identified. The results show that: cohesion of urban networks in China is weak and resource sharing is low. From west to east, the urban network forms a multilevel diamond structure in (...) the periphery, a parallelogram structure in the semiperiphery, and a triangle structure in the center. The spatial distribution of cohesive subgroups is scattered, disobeying the first law of geography. By constructing sub-networks and a comprehensive network, the subnetworks that dominate China’s urban networks were identified and their typical characteristics described. This study clarifies the technical support pattern behind China’s digital economy development and industrial internet construction and provides a basis for policy-makers to optimize the country’s high-quality development in the future. (shrink)

The proposed article is devoted to the description of an intelligent urban passenger transport system based on unmanned electric vehicles, sequentially moving along a separate line. This system is a passenger transport system of a new urban mobility, formed under the influence of social conditions generated by high population density in cities, that suppose the development of pedestrian zones and ecological modes of transport, "transport as a service", etc. In this historical context, public transport systems acquire special (...) relevance. The described transport system belongs to intelligent systems, since it is capable of functioning in autonomous mode without human intervention, adaptively responding to changes in the dynamics of the flow of passengers during the day. Passengers are transported by electric cars, which can be combined into cassettes according to the principle of road trains based on the transportation plan drawn up by the intelligent center of the transport system according to the matrix of correspondences, filled in taking into account the incoming requests for service from passengers. When drawing up a transportation plan, the algorithms of the transport system give preference to transportation according to the "source-destination" principle, that is, when the passenger goes to the destination with a minimum number of intermediate stops, and ideally without them. The paper formulates also a criterion of arising of a conflict in the movement of vehicles, which allows to identify situations when an electric vehicle driving in front can detain vehicles following after. The work has relevance because the criterion will allow to make adjustments in the schedule of movement of vehicles and exclude the loss of time and energy that carries the transport system during braking and acceleration of electric cars, as well as to reduce waiting time and travel of passengers. (shrink)

Visually impaired people have unique perceptions of and usage requirements for various urban spaces. Therefore, understanding these perceptions can help create reasonable layouts and construct urban infrastructure. This study recruited 26 visually impaired volunteers to evaluate 24 sound environments regarding clarity, comfort, safety, vitality, and depression. This data was collected in seven different types of urban spaces. An independent sample non-parametric test was used to determine the significance of the differences between environmental evaluation results for each evaluation (...) dimension and to summarize the compositions of sound and space elements in the positive and negative influence spaces. The results suggested that visually impaired people feel comfort, safety, and clarity in parks, residential communities, and shopping streets; have negative perceptions of vegetable markets, bus stops, hospitals, and urban departments; feel anxious when traffic sounds, horn sounds, manhole cover sounds, and construction sounds occur; and prefer spaces away from traffic, with fewer and slower vehicles, with a suitable space scale, and moderate crowd density. These results provide a reference for the future design of activity venues and the planning of accessibility systems for visually impaired urban residents. (shrink)

Moral epistemology investigates sources and patterns of moral understanding. Its questions include: To what extent does morality consist in or depend on knowledge, and of what kind(s)? What makes possible moral knowledge, and how is such knowledge grounded or justified? What is the relation between philosophical claims about morality and the moral understanding any of us has, that is, what has ethics – the philosophical representation of morality – to do with morality itself? Feminist moral epistemology asks how social divisions (...) of labor, opportunity, power, and recognition which reproduce gender and other hierarchies affect both the ways these questions have in fact been answered, and the ways they might be. (shrink)

Cities are conspicuous among settlements because of their bulk and pace: Venice, Paris, or New York. Each is distinctive, but all share a social structure that mixes systems, their members, and a public regulator. Cities alter this structure in ways specific to themselves: orchestras play music too elaborate for a quartet; city densities promote collaborations unachievable in simpler towns. Cities, Real and Ideal avers with von Bertalanffy, Parsons, Simmel, and Wirth that a theory of social structure is empirically testable and (...) confirmed. It proposes a version of social justice appropriate to this structure, thereby updating Marx s claim that justice is realizable without the intervention of factors additional to society s material conditions.". (shrink)

Context: Philosophical and - more recently - empirical approaches to the study of mind have recognized the research of lived experience as crucial for the understanding of their subject matter. Such research is faced with self-referentiality: every attempt at examining the experience seems to change the experience in question. This so-called “excavation fallacy” has been taken by many to undermine the possibility of first-person inquiry as a form of scientific practice. Problem: What is the epistemic character and value of reflectively (...) acquired phenomenological data? Can the study of experience, despite the excavation fallacy, rely on the act of reflection on lived experience and make sense and use of its results? Method: Through a philosophical discourse, informed by empirical first-person inquiry, we explore the experiential structure of the act of reflection and the formation of the corresponding belief about past experience. Results: We present a provisional first-person model of the experiential dynamics of retrospective reflection, in which the reflective act is characterized as enaction of belief about past experience that co-determines - rather than distorts - its results. From a constructivist perspective on the inevitable interdependence between the act of observing and the observed, the excavation “fallacy” is recognized as an intrinsic characteristic of reflection. Reflection is described as an iterative, self-referential process, guided by a context- and subject-specific horizon of expectations. Implications: Knowing the characteristics of the formation of beliefs about experience is essential for understanding first-person data and for the possibility of their acquisition and use in scientific practice, particularly in the context of second-person approaches to the study of experience. Constructivist content: We relate the proposed understanding of reflection to constructivist epistemology and argue that constructivism provides an epistemological foundation for the empirical study of experience more suitable than the traditional epistemological objectivism of cognitive science. We suggest that the constructive nature of the process of reflection calls for a collaboration between the fields of constructivism, phenomenology, and first-person research, and points towards the potential for their mutual enrichment. (shrink)

The article critically responds to "A Planetary Health Pledge for Health Professionals in the Anthropocene" which was published by Wabnitz et al. in The Lancet in November 2020. It focuses on the different roles and responsibilities of a physician. The pledge is criticised because it neglects the different roles, gives no answers in case of conflicting goals, and contains numerous inconsistencies. The relationship between the Planetary Health Pledge and the Declaration of Geneva is examined. It is argued that the Planetary (...) Health Pledge should have supplemented the Declaration of Geneva instead of changing it. (shrink)

The Hippocratic Oath and the Declaration of Geneva of the World Medical Association are compared in terms of content and origin. Their relevance for current medical practice is investigated. The status which is ascribed to these documents will be shown and the status which they can reasonably claim to have will be explored. Arguments in favor of the Hippocratic Oath that rely on historical stability or historical origin are being examined. It is demonstrated that they get caught up in paradoxes. (...) Should doctors swear the Hippocratic Oath or the Declaration of Geneva? The Hippocratic Oath is a remarkable historic document, which contains important elements still relevant for medical ethics today. Its interpretation as a timeless, still valid medical code is unfounded. The historical arguments, that should justify its validity, are untenable. The Declaration of Geneva, and not the Hippocratic Oath, can legitimately claim to come close to representing the most important principles of professional medical conduct in today’s globalised world. (shrink)

Moral Repair examines the ethics and moral psychology of responses to wrongdoing. Explaining the emotional bonds and normative expectations that keep human beings responsive to moral standards and responsible to each other, Margaret Urban Walker uses realistic examples of both personal betrayal and political violence to analyze how moral bonds are damaged by serious wrongs and what must be done to repair the damage. Focusing on victims of wrong, their right to validation, and their sense of justice, Walker presents (...) a unified and detailed philosophical account of hope, trust, resentment, forgiveness, and making amends - the emotions and practices that sustain moral relations. Moral Repair joins a multidisciplinary literature concerned with transitional and restorative justice, reparations, and restoring individual dignity and mutual trust in the wake of serious wrongs. (shrink)

Personalized medicine plays an important role in the development of current medicine. Among the numerous statements regarding the future of personalized medicine, some can be found that accord medicine a new scientific status. Medicine will be transformed from an art to a science due to personalized medicine. This prognosis is supported by references to models of historical developments. The article examines what is meant by this prognosis, what consequences it entails, and how feasible it is. It refers to the long (...) tradition of epistemological thinking in medicine and the use of historical models for the development of medicine. The possible answers to the question “art or science” are systematized with respect to the core question about the relationship between knowledge and action. The prediction for medicine to develop from an ‘empirical healing art’ to a ‘rational, molecular science’ is nonsensical from an epistemological point of view. The historical models employed to substantiate the development of personalized medicine are questionable. (shrink)

The article presents the judgment of the German Federal Constitutional Court from 26 February 2020 on assisted suicide. The statements regarding human dignity, human rights and the relationship between citizens and the state are examined. Furthermore, the consequences resulting from this interpretation of human dignity for states that are pluralistic and based on human rights will be laid out. The court’s judgment limits the power of parliaments and poses a challenge to many laws in states that see themselves as pluralistic, (...) human rights-based states. There are no data in this work. (shrink)

This is a revised edition of Walker's well-known book in feminist ethics first published in 1997. Walker's book proposes a view of morality and an approach to ethical theory which uses the critical insights of feminism and race theory to rethink the epistemological and moral position of the ethical theorist, and how moral theory is inescapably shaped by culture and history. The main gist of her book is that morality is embodied in "practices of responsibility" that express our identities, values, (...) and connections to others in socially patterned ways. Thus ethical theory needs to be empirically informed and politically critical to avoid reiterating forms of socially entrenched bias. Responsible ethical theory should reveal and question the moral significance of social differences. The book engages with, and challenges, the work of contemporary analytic philosophers in ethics. Moral Understandings has been influential in reaching a global audience in ethics and feminist philosophy, as well as in tangential fields like nursing ethics; research ethics; disability ethics; environmental ethics, and social and political theory. This revised edition contains a new preface, a substantive postscript to Chapter 1 about "the subject of moral philosophy"; the addition of a new chapter on the importance of emotion in practices of responsibility; and the addition of an afterword, which responds to critics of the book. (shrink)

Die Frage, ob sie eine Kunst oder eine Wissenschaft sei, begleitet die Medizin seit der Antike. Die vorliegende Arbeit untersucht die Frage insbesondere im Hinblick auf den Einfluss Kants, Fichtes und Schellings auf das Selbstverstandnis der Medizin. Sie zeichnet die geschichtlichen Linien nach, die zum Verstandnis der gegenwartigen Situation fuhren und liefert wichtige Argumente zu einem zeitgemassen Selbstverstandnis der Medizin, das fur die wissenschaftstheoretische und ethische Diskussion in der Medizin von heute unverzichtbar ist. Since antiquity, the question has been whether (...) medicine is an art or a science. This work explores the question, in particular in view of Kants, Fichtes and Schellings influence on the self-conception of medicine. It traces the historical timelines which help to understand the current situation and provides important arguments for a timely self-conception of medicine which is indispensable for the discussion of scientific theory and ethics in todays medicine. (shrink)

The present article discusses shared epistemological characteristics of two distinct areas of research: the field of first-person inquiry and the field of quantum mechanics. We outline certain philosophical challenges that arise in each of the two lines of inquiry, and point towards the central similarity of their observational situation: the impossibility of disregarding the interrelatedness of the observed phenomena with the act of observation. We argue that this observational feature delineates a specific category of research that we call the non-trivial (...) domain. Unlike the trivial domain, non-trivial research cannot assume the view from nowhere on which the observed phenomena could be regarded as existing independently of the process of observation. Presenting first-person inquiry and quantum mechanics as two of its examples, we show that non-trivial research violates several fundamental observational presuppositions of the trivial domain, exemplified in the principles of classical physics. Drawing on Niels Bohr’s philosophy of quantum mechanics and the constructivist notion of enaction, we stress the constructive, participatory, and irreversible nature of observation in the non-trivial domain. We discuss the possibility of developing a non-representationalist epistemology of the non-trivial, and consider the implications of our discussion for research in the non-trivial domain, as well as for the general understanding of the scientific inquiry. (shrink)

ZusammenfassungDer Artikel untersucht die Frage, ob es sinnvoll ist, Doping im Sport unter ärztlicher Kontrolle freizugeben. Dazu werden die Auswirkungen einer Freigabe untersucht, die stets nur eine begrenzte Freigabe wäre, allein wegen der Risiken. Die unangenehmen Begleiterscheinungen der Dopingkontrollen würden nicht entfallen. Die Auswirkungen einer Freigabe von Doping im Wettkampfsport wären entweder unsinnig oder aber mit Nachteilen behaftet. Es ist nicht notwendig, die Frage zu klären, was die „Idee des Sportes“ ausmacht und ob sie verändert werden darf. Allein unter praktischen (...) Aspekten zeigt sich, dass dem Sport mit einer Freigabe des Dopings keine Vorteile, aber viele Nachteile erwachsen. (shrink)

Background: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as ‘a necessary evil’, confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients’ dignity and autonomy. Aim: To describe nurses’ experiences of being involved in informal coercion in adult psychiatric inpatient care. Research design: The study has a (...) qualitative, inductive design. Participants and research context: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. Ethical considerations: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Findings: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one’s actions and learning together. Discussion: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and ‘house rules’ in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients’ dignity and autonomy. Conclusion: If there is a need for coercion, that is, if the coercion is found to be an ‘unpleasant good’, rather than ‘necessary evil’ considering the consequences for the patient, it should be subject to reflecting and learning together with the patient. (shrink)

First published in 1998. Routledge is an imprint of Taylor & Francis, an informa company.

Zusammenfassung Die Forschungs- und Regulierungsebene bei datenintensiver Forschung in der Medizin liegen auseinander. Ein heterogenes Feld aus regulierenden Institutionen mit regional ungleichen Regelungen, sowohl hinsichtlich der Dichte als auch der Restriktivität von Regelungen, steht einer globalen Entwicklung der Technologien entgegen. Trotz oder gerade wegen mangelnder global-gültiger Regulierungen können auch unverbindliche oder nur bedingt verbindliche normative Vorgaben der Orientierung dienen. Doch wie soll eine solche normative Regulierung angesichts datenintensiver Forschung in der Medizin ausgestaltet werden und woran soll sie sich orientieren? Die (...) Frage, wie konkret und detailliert man eine solche Forschung regulieren sollte, lässt sich nur im Einzelfall für bestimmte Situationen und Institutionen beantworten. Ob dabei neue Normen oder Gewichtungen von Normen vorgenommen werden sollen, oder ob die Normen und deren Gewichtung weiterhin bestehen bleiben sollen, lässt sich nur mit Verweis auf starke normative Argumente beantworten. An zwingenden Argumenten für neue Normen angesichts der datenintensiven medizinischen Forschung mangelt es bisher. Dennoch ist eine Umsetzungsarbeit von Normen, egal ob neue oder alte, und deren Anwendung auf eine neue Methode oder Technologie allemal zu erbringen. Es bedarf daher – wie schon bisher – beider: sowohl etablierter und transparent kommunizierter Normen als auch des unabhängigen Urteils zur Anwendung dieser Normen. Angesichts der besonderen Eignung für diese Aufgabe sollten auch weiterhin Ethik-Kommissionen als prozedurale Instanz bei der Bewilligung von datenintensiver Forschung in der Medizin gefordert und befähigt werden, die als unabhängige Institution ein Urteil im Einzelfall anhand vorgegebener Normen fällen. Nichtsdestotrotz können sich die veränderten Praktiken datenintensiver Forschungsprojekte auch in neuen Anforderungen an Ethik-Kommissionen niederschlagen, denen mit Reformen der Arbeitsweise begegnet werden sollte. (shrink)

The article tries to clarify the relation between history of medicine and medical ethics. Therefore it distinguishes between the double meaning of the german word Geschichte , which means both: development of events and story . For the first option no systematic relation between history and ethics can be reconstructed. In the second sense historical knowledge can be a readable and worth reading text for the ethical debate. Therefore the methodological professionality of the historian is required.

This paper proposes a new classification algorithm for the partitioning of a conceptual space. All the algorithms which have been used until now have mostly been based on the theory of Voronoi diagrams. This paper proposes an approach based on potential theory, with the criteria for measuring similarities between objects in the conceptual space being based on the Newtonian potential function. The notion of a fuzzy prototype, which generalizes the previous definition of a prototype, is introduced. Furthermore, the necessary conditions (...) that a natural concept must meet are discussed. Instead of convexity, as proposed by Gärdenfors, the notion of geodesically convex sets is used. Thus, if a concept corresponds to a set which is geodesically convex, it is a natural concept. This definition applies, for example, if the conceptual space is an Euclidean space. As a by-product of the construction of the algorithm, an extension of the conceptual space to d-dimensional Riemannian manifolds is obtained. (shrink)

Theranostics or theragnostics are new terms which start to appear occasionally in publications from 2001 onwards, with a marked increase in references from 2011. In the last few years more than 1100 articles using this term were published each year. In 2011 the journal Theranostics was founded. This paper addresses the question of whether this new term is appropriate. The etymology of the term is analysed. A literature search for definitions of “theranostics” is carried out and the definitions examined as (...) to whether they give grounds for justifying the use of a new term. The differences between diagnostics and therapy are explored. A broad and a narrow definition are found. According to the broad definition theranostics provides a closer relationship between diagnostics and therapy. According to the narrow definition diagnostics and therapy become a single intervention. On closer examination it turns out that in the narrow definition the diagnostics capacities are limited to monitoring. Neither the broad nor the narrow definition actually demonstrate a new concept in medicine. Rather, they describe the well-known practice of medical decision making. In this respect, the new term cannot be justified. The level of diagnostics is new but not the relationship between diagnostics and therapy. The term theranostics is misleading as it obscures the existing differences between diagnostics and therapy and wrongly insinuates that steps between diagnostics and therapy could be omitted. (shrink)

BackgroundIndividuals with early phase cognitive impairment are frequently affected by existential distress, social avoidance and associated health issues. The demand for efficient psychological support is crucial from both an individual and a societal perspective. We have developed a novel psychological intervention manual for providing a non-medical path to enhanced psychological health in the cognitively impaired population. The current article provides specific information on the randomized controlled trial -design and methods. The main hypothesis is that participants receiving PIPCI will increase their (...) psychological flexibility compared to participants in the active control group and the waiting list control group. The secondary hypotheses are that participants receiving PIPCI will improve psychological health compared to participants in the active control group and the waiting list control group.Materials and MethodsThis three-arm RCT will recruit participants from the cognitive centers at Karolinska University Hospital in Stockholm and randomize approximately 120 individuals in the early phase of cognitive impairment to either an experimental group, an active control group or a waiting list control group. Intervention outcome will be evaluated with self-report questionnaires on physical and psychological aspects of health, cognitive assessment, biological markers and health care costs. Assessments will be performed at pre- and post-intervention, as well as at a 6-month follow-up.DiscussionThe development of a potentially feasible and effective psychological intervention tailored for early phase cognitive impairment has the potential to advance the non-pharmacological intervention field. This is especially important given the extensive burden for many affected individuals and their families and the current lack of effective treatments. If the psychological intervention discussed here shows feasibility and efficacy, there is potential for far-reaching healthcare implications for patients with early cognitive impairment at risk of developing dementia.Clinical Trial RegistrationClinicalTrials.gov: NCT04356924. Date of registration: April 22, 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04356924. (shrink)