Making publics visible through digital traces has recently generated interest by practitioners of public engagement and scholars within the field of digital methods. This paper presents an experiment in moving such methods into critical proximity with political practice and discusses how digital visualizations of topical debates become appropriated by actors and hardwired into existing ecologies of publics and politics. Through an experiment in rendering a specific data-public visible, it shows how the interplay between diverse conceptions of the public as well (...) as the specific platforms and data invoked, resulted in a situated affordance-space that allowed specific renderings take shape, while disadvantaging others. Furthermore, it argues that several accepted tropes in the literatures of digital methods ended up being problematic guidelines in this space. Among these is the prescription to shown heterogeneity by pushing back at established media logics. (shrink)

According to Clifford Geertz, the purpose of anthropology is not to explain culture but to explicate it. That should cause us to rethink our relationship with machine learning. It is, we contend, perfectly possible that machine learning algorithms, which are unable to explain, and could even be unexplainable themselves, can still be of critical use in a process of explication. Thus, we report on an experiment with anthropological AI. From a dataset of 175K Facebook comments, we trained a neural network (...) to predict the emoji reaction associated with a comment and asked a group of human players to compete against the machine. We show that a) the machine can reach the same accuracy as the players, b) it fails in roughly the same ways as the players, and c) easily predictable emoji reactions tend to reflect unambiguous situations where interpretation is easy. We therefore repurpose the failures of the neural network to point us to deeper and more ambiguous situations where interpretation is hard and explication becomes both necessary and interesting. We use this experiment as a point of departure for discussing how experiences from anthropology, and in particular the tension between formalist ethnoscience and interpretive thick description, might contribute to debates about explainable AI. (shrink)

The present article offers a discussion of the question 'Why study Cohen?′. The author′s first and preliminary answer to the question is that the study of Hermann Cohen′s thought is relevant for contemporary philosophy for at least five reasons. They include Cohen′s improvement of critical idealism of the subject which he substitutes with his idealism of the idea; the exposition of thought as an ethics of law; the articulation of the notion of anticipation as the principle of time, history, and (...) interpretation; the exposition of critical idealism as a form of idealism that is not violent, totalitarian or reductive, but idealism in terms of alterity and the other, instead; the role of history and especially the history of the religion of Judaism in the construction of the religion of reason and the conception of Judaism. (shrink)

“Love hurts”—as the saying goes—and a certain amount of pain and difficulty in intimate relationships is unavoidable. Sometimes it may even be beneficial, since adversity can lead to personal growth, self-discovery, and a range of other components of a life well-lived. But other times, love can be downright dangerous. It may bind a spouse to her domestic abuser, draw an unscrupulous adult toward sexual involvement with a child, put someone under the insidious spell of a cult leader, and even inspire (...) jealousy-fueled homicide. How might these perilous devotions be diminished? The ancients thought that treatments such as phlebotomy, exercise, or bloodletting could “cure” an individual of love. But modern neuroscience and emerging developments in psychopharmacology open up a range of possible interventions that might actually work. These developments raise profound moral questions about the potential uses—and misuses—of such anti-love biotechnology. In this article, we describe a number of prospective love-diminishing interventions, and offer a preliminary ethical framework for dealing with them responsibly should they arise. (shrink)

'Brainjacking’ refers to the exercise of unauthorized control of another’s electronic brain implant. Whilst the possibility of hacking a Brain–Computer Interface (BCI) has already been proven in both experimental and real-life settings, there is reason to believe that it will soon be possible to interfere with the software settings of the Implanted Pulse Generators (IPGs) that play a central role in Deep Brain Stimulation (DBS) systems. Whilst brainjacking raises ethical concerns pertaining to privacy and physical or psychological harm, we claim (...) that the possibility of brainjacking DBS raises particularly profound concerns about individual autonomy, since the possibility of hacking such devices raises the prospect of third parties exerting influence over the neural circuits underpinning the subject’s cognitive, emotional and motivational states. However, although it seems natural to assume that brainjacking represents a profound threat to individual autonomy, we suggest that the implications of brainjacking for individual autonomy are complicated by the fact that technologies targeted by brainjacking often serve to enhance certain aspects of the user’s autonomy. The difficulty of ascertaining the implications of brainjacking DBS for individual autonomy is exacerbated by the varied understandings of autonomy in the neuroethical and philosophical literature. In this paper, we seek to bring some conceptual clarity to this area by mapping out some of the prominent views concerning the different dimension of autonomous agency, and the implications of brainjacking DBS for each dimension. Drawing on three hypothetical case studies, we show that there could plausibly be some circumstances in which brainjacking could potentially be carried out in ways that could serve to enhance certain dimensions of the target’s autonomy. Our analysis raises further questions about the power, scope, and necessity of obtaining prior consent in seeking to protect patient autonomy when directly interfering with their neural states, in particular in the context of self-regulating closed-loop stimulation devices. (shrink)

We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many (...) of the processes within an evidence-based practice framework are better accounted for. Further, some of the problems associated with the health research, e.g. external validity of causal findings, dissolve. (shrink)

Medically unexplained symptoms (MUS) remain recalcitrant to the medical profession, proving less suitable for homogenic treatment with respect to their aetiology, taxonomy and diagnosis. While the majority of existing medical research methods are designed for large scale population data and sufficiently homogenous groups, MUS are characterised by their heterogenic and complex nature. As a result, MUS seem to resist medical scrutiny in a way that other conditions do not. This paper approaches the problem of MUS from a philosophical point of (...) view. The aim is to first consider the epistemological problem of MUS in a wider ontological and phenomenological context, particularly in relation to causation. Second, the paper links current medical practice to certain ontological assumptions. Finally, the outlines of an alternative ontology of causation are offered which place characteristic features of MUS, such as genuine complexity, context-sensitivity, holism and medical uniqueness at the centre of any causal set-up, and not only for MUS. This alternative ontology provides a framework in which to better understand complex medical conditions in relation to both their nature and their associated research activity. (shrink)

Background As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency (...) medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability. Methods A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis. Results Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting. Conclusions Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values. (shrink)

In September 2015 a well-publicised Campaign Against Sex Robots (CASR) was launched. Modelled on the longer-standing Campaign to Stop Killer Robots, the CASR opposes the development of sex robots on the grounds that the technology is being developed with a particular model of female-male relations (the prostitute-john model) in mind, and that this will prove harmful in various ways. In this chapter, we consider carefully the merits of campaigning against such a technology. We make three main arguments. First, we argue (...) that the particular claims advanced by the CASR are unpersuasive, partly due to a lack of clarity about the campaign’s aims and partly due to substantive defects in the main ethical objections put forward by campaign’s founder(s). Second, broadening our inquiry beyond the arguments proferred by the campaign itself, we argue that it would be very difficult to endorse a general campaign against sex robots unless one embraced a highly conservative attitude towards the ethics of sex, which is likely to be unpalatable to those who are active in the campaign. In making this argument we draw upon lessons from the campaign against killer robots. Finally, we conclude by suggesting that although a generalised campaign against sex robots is unwarranted, there are legitimate concerns that one can raise about the development of sex robots. (shrink)

BackgroundIn childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe (...) the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.MethodsThis study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.ResultsData was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows:Interprofessional well-being in team interactionson a team level;Professional comfort when dealing with moral challengeson a personal level; andImproved quality of care for the child and the familyon a care level.ConclusionsHealthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support. (shrink)

In this article Doret J. de Ruyter and Anders Schinkel argue that parents' ideals can enhance children's autonomy, but that they may also have a detrimental effect on the development of children's autonomy. After describing the concept of ideals and elucidating a systems theoretical conception of autonomy, de Ruyter and Schinkel explore the ways in which the ideals of parents may play a role in the development of their children's autonomy. They show that abstract and complex ideals of parents (...) (be it ideals for their children, ideals with regard to their parenthood, or their personal ideals) are most likely to enhance their children's autonomy. They also explain that an authoritative parenting style is most conducive to autonomy, although whether or not it does benefit children's autonomy also depends on the types of ideals pursued by parents. (shrink)

Background Childhood cancers affect about 350 children every year in Sweden and are life-threatening diseases. During the treatment period, situations arise that can become morally challenging for the child. When knowing children’s values and morally challenging situations in childhood cancer care, targeted ethics support could be developed and used in care. Aim To explore children’s values and moral dilemmas ​​when undergoing cancer treatment. Methods This is a qualitative study based on empirical data. The data collection was conducted through three focus (...) group interviews and six individual interviews with children between 10 and 18 years (n = 16). A content analysis methodology was used to generate themes. Children who were/have been treated for cancer at three childhood cancer centres in Sweden were invited to participate. The study was approved by the Swedish Ethical Review Authority. The children’s participation was based on voluntariness and consent/assent. Findings During the analysis, five themes of values emerged: Personal relationships, Bodily ease and identity, Feeling in control and being involved, Positive distractions and Right care that is needed. Their moral dilemmas were thematized into: Should I consider others or not? Should I rest or not? and Should I refuse treatment or not? Conclusion Children undergoing cancer treatment want to have personal relationships with healthcare professionals. Their moral dilemmas were about questioning their own physical and psychological well-being against their expectations, the values of others and the treatment required. Further research is needed to understand how to deal with moral dilemmas in children undergoing cancer treatment. (shrink)

Empathy is crucial for the quality of social interactions and thus highly relevant in human service professions. At the same time, people belonging to this occupational group are especially vulnerable to developing burnout symptoms. With this study, we aimed to investigate the causal link between burnout symptoms and empathy by using a novel experimental design. Our participants (N = 355; 44.5% women; Mage = 36.37) filled out an online questionnaire; in an autobiographical memory task, the experimental group retrieved previous burnout (...) experiences, whereas one control group retrieved a neutral memory and another control group received no intervention. After measuring current burnout symptoms as a manipulation check, we measured the cognitive and affective empathy of all participants. Findings indicate that the experimental group reported significantly higher burnout symptoms compared to control groups, validating our intervention method. Furthermore, we found that the experimental group scored lower on one of the cognitive empathy measures, suggesting negative effects on the relational skills of burned-out individuals. Results are discussed with regard to ecological validity and implications. (shrink)

The era of ‘big data’ studies and computational social science has recently given rise to a number of realignments within and beyond the social sciences, where otherwise distinct data formats – digital, numerical, ethnographic, visual, etc. – rub off and emerge from one another in new ways. This article chronicles the collaboration between a team of anthropologists and sociologists, who worked together for one week in an experimental attempt to combine ‘big’ transactional and ‘small’ ethnographic data formats. Our collaboration is (...) part of a larger cross-disciplinary project carried out at the Danish Technical University, where high-resolution transactional data from smartphones allows for recordings of social networks amongst a freshman class. With a parallel deployment of ethnographic fieldwork among the DTU students, this research set-up raises a number of questions concerning how to assemble disparate ‘data-worlds’ and to what epistemological and political effects? To address these questions, a specific social event – a lively student party – was singled out from the broader DTU dataset. Our experimental collaboration used recordings of Bluetooth signals between students’ phones to visualize the ebb and flow of social intensities at the DTU party, juxtaposing these with ethnographic field-notes on shifting party atmospheres. Tracing and reflecting on the process of combining heterogeneous data, the article offers a concrete case of how a ‘stitching together’ of digital and ethnographic data-worlds might take place. (shrink)

Worldwide implementation of the centrat concept sustainable development has given rise to very different interpretations, some extending to central issues within the field of ecological ethics. This is especially true of the two economic approaches termed >Strong weak weak strong< sustainability theory merits interdisciplinary consideration through a theologically oriented ethics of sustainable development.

BackgroundThe values and attitudes of healthcare professionals influence their handling of ‘do-not-attempt-resuscitation’ (DNAR) orders. The aim of this study was a) to describe attitudes, perceptions and practices among Swedish physicians and nurses towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and b) to investigate if the physicians and nurses were familiar with the national ethical guidelines for cardiopulmonary resuscitation.MethodsThis was a retrospective observational study based on a questionnaire and was conducted at 19 wards in two regional (...) hospitals and one county hospital.Results210 physicians and 312 nurses (n = 522) responded to the questionnaire. Every third (35%) professional had read the guidelines with a lower proportion of physicians (29%) compared to nurses (38%). Around 40% of patients had the opportunity or ability to participate in the DNAR discussion. The DNAR decision was discussed with 38% of patients and the prognosis with 46%. Of the patients who were considered to have the ability to participate in the discussion, 79% did so. The majority (81%) of physicians and nurses believed that patients should always be asked about their preferences before a DNAR decision was made.ConclusionsSwedish healthcare professionals take a patient’s autonomy into account regarding DNAR decisions. Nevertheless, as 50% of patients were considered unable to participate in the DNAR discussion, questions remain about the timing of patient participation and whether more discussions could have been conducted earlier. Given the uncertainty about timing, the majority of patients deemed competent participated in DNAR discussions. (shrink)

miembro del Future of Humanity Institute de la Universidad de Oxford y experto en mejoramiento humano y transhumanismo, sobre cuestiones centrales de su labor investigadora.PALABRAS CLAVETRANSHUMANISMO, MEJORAMIENTO HUMANO, ANDERS SANDBERG, BIOTECNOLOGÍAABSTRACTInterview with Anders Sandberg, member of the Future of Humanity Institute at Oxford University and expert in human enhancement and transhumanism, about central topics in his works.KEYWORDSTRANSHUMANISM, HUMAN ENHANCEMENT, ANDERS SANDBERG,BIOTECHNOLOGY.

The PRDM family has recently spawned considerable interest as it has been implicated in fundamental aspects of cellular differentiation and exhibits expanding ties to human diseases. The PRDMs belong to the SET domain family of histone methyltransferases, however, enzymatic activity has been determined for only few PRDMs suggesting that they act by recruiting co‐factors or, more speculatively, confer methylation of non‐histone targets. Several PRDM family members are deregulated in human diseases, most prominently in hematological malignancies and solid cancers, where they (...) can act as both tumor suppressors or drivers of oncogenic processes. The molecular mechanisms have been delineated for only few PRDMs and little is known about functional redundancy within the family. Future studies should identify target genes of PRDM proteins and the protein complexes in which PRDM proteins reside to provide a more comprehensive understanding of the biological and biochemical functions of this important protein family. (shrink)

The doctorate forms the basis for academic careers and the regeneration of academia, and has increasingly become important for other sectors of society. The latter is reflected in efforts on institutional, national as well as supranational levels to change and adapt the doctoral degree to new expectations. As doctoral education is embedded in research, changes in governance and funding of research further affect the doctorate. The evaluation of the doctoral thesis appears, however, to have remained true to the academic tradition: (...) an examination committee exercising their gatekeeping in a ceremonial setting. This study sets out to explore doctoral examination committees’ evaluation practices. Insights were gained through six focus group interviews with experienced examination committee members at three large research-intensive universities in Sweden. Of particular interest is how the object of evaluation is formed, the nature of the boundary-work conducted, and variations in examination practices related to different and changing conditions for research and doctoral education. Our results show how the object of evaluation emerges through a gradual interpretation of the thesis and defence, becoming more complex and nuanced as the process of evaluation progresses from its initial stages to the final closed discussions of the committee. The finalised object of evaluation, only fully present at the conclusion of the closed meeting and hence transient in nature, encompasses the research contribution, educational achievement, and academic competence of the candidate. Furthermore, the boundary-work conducted in this process often transcends the object of evaluation to include also supervision and the local context for doctoral education and research, and hence contributes to upholding, and potential changing, norms in research fields, educational contexts, and academia at large. This extended boundary-work intensified as problems and inconsistencies were discovered during the evaluation process. The ceremonial staging underscored the gravity of the decision and the extended boundary-work. Despite changing conditions for the doctorate, our findings highlight the importance of the practice of evaluation committees, and the disciplinary communities to which they belong, for upholding and negotiating norms in academia. (shrink)

Berg, J. Buñuels dagdröm.--Bergström, L. Pessimismens konsekvenser.--Furberg, M. Möjliga teser hos Johannes Climacus.--Halldén, S. Teckenrelationen och språkreglernas juridik.--Hedenius, I. Ett argument mot den rättsfilosofiska domstolsrealismen.--Mates, B. Om Platons argument "den tredje människan."--Marc-Wogau, K. Kant om lögnen.--Næss, A. Om filosofiske projekter som forener empirisk semantikk og metafysisk spekulasjon.--Ofstad, H. Får nazister lettere magesår enn humanister?--Prawitz, D. Om moraliska och logiska satsers sanning.--Stenius, E. Om Descartes' psykofysiska modell.--Tranøy, K. E. Filosofenes etiske ansvar.--Wright, G. H. von. En filosof ser på filosofien.

It has often been noted that liberal democracies are facing a serious political crisis. A common reaction to this situation is to call for more comprehensive or more effective liberal democratic education. This volume discusses some of the most important challenges to and critiques of the paradigm of liberal democratic education. In doing so, it offers novel insights into how liberal democratic education can be amended, extended or qualified to address the special challenges of the current political moment.

Rapid individual cognitive phenotyping holds the potential to revolutionize domains as wide‐ranging as personalized learning, employment practices, and precision psychiatry. Going beyond limitations imposed by traditional lab‐based experiments, new efforts have been underway toward greater ecological validity and participant diversity to capture the full range of individual differences in cognitive abilities and behaviors across the general population. Building on this, we developed Skill Lab, a novel game‐based tool that simultaneously assesses a broad suite of cognitive abilities while providing an engaging (...) narrative. Skill Lab consists of six mini‐games as well as 14 established cognitive ability tasks. Using a popular citizen science platform (N = 10,725), we conducted a comprehensive validation in the wild of a game‐based cognitive assessment suite. Based on the game and validation task data, we constructed reliable models to simultaneously predict eight cognitive abilities based on the users’ in‐game behavior. Follow‐up validation tests revealed that the models can discriminate nuances contained within each separate cognitive ability as well as capture a shared main factor of generalized cognitive ability. Our game‐based measures are five times faster to complete than the equivalent task‐based measures and replicate previous findings on the decline of certain cognitive abilities with age in our large cross‐sectional population sample (N = 6369). Taken together, our results demonstrate the feasibility of rapid in‐the‐wild systematic assessment of cognitive abilities as a promising first step toward population‐scale benchmarking and individualized mental health diagnostics. (shrink)

Linkage of population-based administrative data is a valuable tool for combining detailed individual-level information from different sources for research. While not a substitute for classical studies based on primary data collection, analyses of linked administrative data can answer questions that require large sample sizes or detailed data on hard-to-reach populations, and generate evidence with a high level of external validity and applicability for policy making. There are unique challenges in the appropriate research use of linked administrative data, for example with (...) respect to bias from linkage errors where records cannot be linked or are linked together incorrectly. For confidentiality and other reasons, the separation of data linkage processes and analysis of linked data is generally regarded as best practice. However, the ‘black box’ of data linkage can make it difficult for researchers to judge the reliability of the resulting linked data for their required purposes. This article aims to provide an overview of challenges in linking administrative data for research. We aim to increase understanding of the implications of the data linkage environment and privacy preservation; the linkage process itself and linkage quality and potential bias in linked data. We draw on examples from a number of countries to illustrate a range of approaches for data linkage in different contexts. (shrink)

This book analyses three of the most prevalent illnesses of late modernity: anxiety, depression and Alzheimer’s disease, in terms of their relation to cultural pathologies of the social body. Usually these conditions are interpreted clinically in terms of individualized symptoms and responded to discretely, as though for the most part unrelated to each other. However, these diseases also have a social and cultural profile that transcends their particular symptomologies and etiologies. Anxiety, depression and Alzheimer’s are diseases related to disorders of (...) the collective esprit de corps of contemporary society. Multidisciplinary in approach, the book addresses questions of how these conditions are manifest at both the individual and collective levels in relation to hegemonic biomedical and psychologistic understandings. Rejecting such reductive diagnoses, the authors argue that anxiety, depression and Alzheimer’s disease, as well as other contemporary epidemics, are to be analysed in the light of individual and collective experiences of profound and radical changes in our civilization. A diagnosis of our times, Late Modern Subjectivity and its Discontents will appeal to a broad range of scholars with interests in health and illness, the sociology of medicine and contemporary life. (shrink)

Is the assessment of motor milestones valid and scaled equivalently for all infants? It is not only important to understand if the way we use gross and fine motor scores are appropriate for monitoring motor milestones but also to determine if these scores are confounded by specific infant characteristics. Therefore, the aim of the study is to investigate the latent structure underlying motor milestone assessment in infancy and measurement invariance across sex, birth weight, and gestational age. For this study, the (...) birth cohort data from the United Kingdom Millennium Cohort Study was used, which includes the assessment of eight motor milestone tasks from the Denver Developmental Screening Test in 9-month-old infants, depicting early motor development of the first children of generation Z. Confirmatory factor analyses showed a better model fit for a two-factor structure compared to a one-factor structure, and multiple indicators multiple causes modeling revealed no differential item functioning related to sex, birth weight, and gestational age. The study provides support for the use of gross and fine motor scores when assessing motor milestones in infants—both boys and girls with different birth weights and of varying gestational ages. Further investigation into widely adopted assessment tools is recommended to support the use of valid composite scores in early childhood research and practice. (shrink)

Background Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process. Aim The aim of (...) this study was to describe ambulance clinicians’ conceptions of responsibility when encountering patients in a suicidal process. Research design A qualitative inductive design using a phenomenographic approach was used. Participants and research context Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed. Ethical considerations The study was approved by the Swedish Ethical Review Authority. Findings Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient’s mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient’s life story. Conclusions An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation. (shrink)

Much research aimed at developing measures for normative criteria to guide the assessment of healthcare resource allocation decisions has focused on health maximization, equity concerns and more recently approaches based on health capabilities. However, a widely embraced idea is that health resources should be allocated to meet health needs. Little attention has been given to the principle of need which is often mentioned as an alternative independent criteria that could be used to guide healthcare evaluations. This paper develops a model (...) and indicator of need satisfaction that aggregates the health needs of a population in a particular time period into a single measure that weights individual health needs by the severity of their ill health. The paper provides a first step towards formalizing the principle of need as a measurable objective for healthcare policy and we discuss some challenges for future research, including incorporating the duration of time into need-based health evaluations. (shrink)

The loss of a loved one can be a devastating blow, its impact unpredictable and often perplexing. In this sensitively written volume, letters to a young man offer solace, strength and rare insight. The correspondence format allow Meir Munk to.

A wide range of gene knockout experiments shows that functional stability is an important feature of biological systems. On this backdrop, we present an argument for higher‐level causation based on counterfactual dependence. Furthermore, we sketch a metaphysical picture providing resources to explain the metaphysical nature of functional stability, higher‐level causation, and the relevant notion of levels. Our account aims to clarify the role empirical results and philosophical assumptions should play in debates about reductionism and higher‐level causation. It thereby contributes to (...) the development of a philosophical foundation for systems biology. †To contact the authors, please write to: CSMN/IFIKK, University of Oslo, Box 1020 Blindern, N‐0315, Oslo, Norway; e‐mail: anders[email protected] , [email protected]. (shrink)

Chronic post-surgical pain (CPSP) represents a highly prevalent and significant clinical problem. Both major and minor surgeries entail risks of developing CPSP, and cancer-related surgery is no exception. As an example, more than 40% of women undergoing breast cancer surgery struggle with CPSP years after surgery. While we do not fully understand the pathophysiology of CPSP, we know it is multifaceted with biological, social, and psychological factors contributing. The aim of this review is to advocate for the role of response (...) outcome expectancies in the development of CPSP following breast cancer surgery. We propose the Cognitive Activation Theory of Stress (CATS) as an applicable theoretical framework detailing the potential role of cortisol regulation, inflammation, and inflammatory-induced sickness behavior in CPSP. Drawing on learning theory and activation theory, CATS offers psychobiological explanations for the relationship between stress and health, where acquired expectancies are crucial in determining the stress response and health outcomes. Based on existing knowledge about risk factors for CPSP, and in line with the CATS position, we propose the SURGEry outcome expectancy (SURGE) model of CPSP. According to SURGE, expectancies impact stress physiology, inflammation, and fear-based learning influencing the development and persistence of CPSP. SURGE further proposes that generalized response outcome expectancies drive adaptive or maladaptive stress responses in the time around surgery, where coping dampens the stress response, while helplessness and hopelessness sustains it. A sustained stress response may contribute to central sensitization, alterations in functional brain networks and excessive fear-based learning. This sets the stage for a prolonged state of inflammatory-induced sickness behavior – potentially driving and maintaining CPSP. Finally, as psychological factors are modifiable, robust and potent predictors of CPSP, we suggest hypnosis as an effective intervention strategy targeting response outcome expectancies. We here argue that presurgical clinical hypnosis has the potential of preventing CPSP in women with breast cancer. (shrink)