The study of rare diseases has long been an area of challenge for medical researchers, with agonizingly slow movement towards improved understanding of pathophysiology and treatments compared with more common illnesses. The push towards evidence-based medicine (EBM), which prioritizes certain types of evidence over others, poses a particular issue when mapped onto rare diseases, which may not be feasibly investigated using the methodologies endorsed by EBM, due to a number of constraints. While other trial designs have been suggested to overcome (...) these limitations (with varying success), perhaps the most recent and enthusiastically adopted is the application of artificial intelligence to rare disease data. This paper critically examines the pitfalls of EBM (and its trial design offshoots) as it pertains to rare diseases, exploring the current landscape of AI as a potential solution to these challenges. This discussion is also taken a step further, providing philosophical commentary on the weaknesses and dangers of AI algorithms applied to rare disease research. While not proposing a singular solution, this article does provide a thoughtful reminder that no ‘one-size-fits-all’ approach exists in the complex world of rare diseases. We must balance cautious optimism with critical evaluation of new research paradigms and technology, while at the same time not neglecting the ever-important aspect of patient values and preferences, which may be challenging to incorporate into computer-driven models. (shrink)

Controlled Human Infection Model (CHIM) research involves the infection of otherwise healthy participants with disease often for the sake of vaccine development. The COVID-19 pandemic has emphasised the urgency of enhancing CHIM research capability and the importance of having clear ethical guidance for their conduct. The payment of CHIM participants is a controversial issue involving stakeholders across ethics, medicine and policymaking with allegations circulating suggesting exploitation, coercion and other violations of ethical principles. There are multiple approaches to payment: reimbursement, wage (...) payment and unlimited payment. We introduce a new Payment for Risk Model, which involves paying for time, pain and inconvenience and for risk associated with participation. We give philosophical arguments based on utility, fairness and avoidance of exploitation to support this. We also examine a cross-section of the UK public and CHIM experts. We found that CHIM participants are currently paid variable amounts. A representative sample of the UK public believes CHIM participants should be paid approximately triple the UK minimum wage and should be paid for the risk they endure throughout participation. CHIM experts believe CHIM participants should be paid more than double the UK minimum wage but are divided on the payment for risk. The Payment for Risk Model allows risk and pain to be accounted for in payment and could be used to determine ethically justifiable payment for CHIM participants.Although many research guidelines warn against paying large amounts or paying for risk, our empirical findings provide empirical support to the growing number of ethical arguments challenging this status quo. We close by suggesting two ways (value of statistical life or consistency with risk in other employment) by which payment for risk could be calculated. (shrink)

Es geht um Carnaps Konstitution der Qualitätsklassen (qual) mittels der Methode der Quasianalyse. Diese Konstitutionsmethode hat Carnap in seinem Werk Der logische Außau der Welt verwendet. Es wird gezeigt, daß Carnaps Qualitätsdefinition sowohl an technischen als auch an grundsätzlichen Mängeln scheitert. Des weiteren werden Verbesserungsvorschläge der Camapschen Methode, die von Brockhaus, Goodman, Moulines und Eberle gemacht worden sind, untersucht und als inadäquat nachgewiesen.

Background: Nursing practice takes place in a social framework, in which environmental elements and interpersonal relations interact. Ethical climate of the work unit is an important element affecting nurses’ professional and ethical practice. Nevertheless, whatever the environmental circumstances, nurses are expected to be professionally competent providing high-quality care ethically and clinically. Aim: This study examined newly graduated nurses’ perception of the ethical climate of their work environment and its association with their self-assessed professional competence, turnover intentions and job satisfaction. Method: (...) Descriptive, cross-sectional, correlational research design was applied. Participants consisted of 318 newly graduated nurses. Data were collected electronically and analysed statistically. Ethical considerations: Ethical approval and permissions to use instruments and conduct the study were obtained according to required procedures. Data were rendered anonymous to protect participant confidentiality. Completing the questionnaire was interpreted as consent to participate. Findings: Nurses’ overall perception of the ethical climate was positive. More positive perceptions related to peers, patients and physicians, and less positive to hospitals and managers. Strong associations were found between perceived ethical climate and self-assessed competence, turnover intentions in terms of changing job, and job satisfaction in terms of quality of care. Nurses at a higher competence level with positive views of job satisfaction and low turnover intentions perceived the climate significantly more positively. Conclusion: Nursing management responsible for and having the power to implement changes should understand their contribution in ethical leadership, as well as the multidimensional nature of nurses’ work environment and the interaction between work-related factors in planning developmental measures. Future research should focus on issues in nurse managers’ ethical leadership in creating ethical work environments. There is also a need for knowledge of newly graduated nurses’ views of factors which act as enhancers or barriers to positive ethical climates to develop. Interventions, continuing education courses, and discussions designed to promote positive ethical climates should be developed for managers, nurses, and multi-professional teams. (shrink)

Empathy is a form of emotionally charged imaginative perspective‐taking. It is also the unique source of a particular form of understanding, which I will call humane understanding. Humane understanding consists in the direct apprehension of the intelligibility of others’ emotions. This apprehension is an epistemic good whose ethical significance is multifarious. In this paper, I focus on elaborating the sense in which humane understanding of others is non‐instrumentally valuable to its recipients. People have a complex but profound need to be (...) humanely understood. Because we respond to others’ very real need when we pursue this sort of understanding of their emotions, empathy is best understood as itself a way of caring, rather than just a means to promote other caring behavior. (shrink)

Several studies have illuminated how processing manual action verbs (MaVs) affects the programming or execution of concurrent hand movements. Here, to circumvent key confounds in extant designs, we conducted the first assessment of motor–language integration during handwriting—a task in which linguistic and motoric processes are co‐substantiated. Participants copied MaVs, non‐manual action verbs, and non‐action verbs as we collected measures of motor programming and motor execution. Programming latencies were similar across conditions, but execution was faster for MaVs than for the other (...) categories, regardless of whether word meanings were accessed implicitly or explicitly. In line with the Hand‐Action‐Network Dynamic Language Embodiment (HANDLE) model, such findings suggest that effector‐congruent verbs can prime manual movements even during highly automatized tasks in which motoric and verbal processes are naturally intertwined. Our paradigm opens new avenues for fine‐grained explorations of embodied language processes. (shrink)

Im folgenden Beitrag wird ein neuartiger Vorschlag zur Lösung des Antinomienproblems untersucht. Die Untersuchung ergibt, daß der Vorschlag in toto untauglich ist. Weiterhin wird die Unhaltbarkeit gewisser Argumente gegen den Beweis des ersten Gödelschen Unvollständigkeitstheorems nachgewiesen.

In Wittgenstein on Rules and Private Language, Saul Kripke articulates a form of scepticism about meaning. Even though there is considerable disagreement among critics about the reasoning in which the sceptic engages, there is little doubt that he seeks to offer constraints for an adequate account of the facts that constitute the meaningfulness of expressions. Many of the sceptic's remarks concern the nature of the guidance involved in a speaker's meaningful uses of expressions. I propose that we understand those remarks (...) as seeking to give shape to the idea that to use an expression under the guidance of one's understanding is to have a reason for that use, which one's understanding allows one to discern and act on. Any philosophical elucidation of meaning must adequately capture the rational nature of our linguistic acts. (shrink)

In this introductory essay, I articulate a puzzle that is central for our understanding of ourselves as minded beings bound to live finite lives. I argue that our finitude is not something that can be set aside for the purposes of the philosophical inquiry into the mind. Grappling with it is an essential component of this inquiry.

Background: In the context of new reimbursement systems like diagnosis-related groups, moral distress is becoming a growing problem for healthcare providers. Moral distress can trigger emotional and physical reactions in nurses and can cause them to withdraw emotionally from patients or can cause them to change their work place. Objective: The aim of this pilot study was to develop an instrument to measure moral distress among acute care nurses in the German-speaking context, to test its applicability, and to obtain initial (...) indications of the instrument’s validity. Method: The study was designed in 2011 as a cross-sectional pilot survey. Conducted on eight units of one university hospital in German-speaking Switzerland, 294 registered nurses were asked to fill out a web-based questionnaire on moral distress. Ethical considerations: The study proposal was approved by the cantonal ethics committee. All participating nurses provided informed consent and were assured of data confidentiality. Results: The survey had a response rate of 55%. The results show the prevalence of statements on the questionnaire indicating situations with the potential to trigger moral distress. The entire range of answers was used in the responses. Most participants found the questionnaire comprehensible, while some criticized the phraseology of certain statements. Many more found the registration process prior to online access to be too time consuming. Nurses confirmed that the results reflect their subjective assessment of their situation and their experience of moral distress. Conclusion: The newly developed moral distress questionnaire appears to produce face validity and is sufficiently applicable for use in our study. The results indicate that moral distress appears to be a relevant phenomenon also in Swiss hospitals and that nurses were experiencing it prior to the introduction of Swiss diagnosis-related groups. (shrink)

Are extremists (incels, neo-nazis, and the like) characteristically answerable for their moral and political convictions? Is it necessary to offer them reasoned arguments against their views, or is it instead appropriate to bypass that kind of engagement? Discussion of these questions has centered around the putative epistemic autonomy of extremists. The parties to this discussion have assumed that epistemic autonomy is solely (or at least primarily) a matter of epistemic independence, of believing based on epistemic reasons one has assessed for (...) oneself. Here, though, I make the case for shifting the terms of the debate. Epistemic independence is not sufficient to make one answerable for one’s beliefs. Epistemic autonomy, in the sense that matters for answerability, is also a matter of what I call epistemic receptivity. Extremists may be fiercely epistemic independent, but that commitment is characteristically paired with severe deficiencies in empathic orientation. Severe deficiencies in empathic orientation undermine extremists’ ability to adequately engage with competing evaluative perspectives, and thus compromise extremists’ epistemic autonomy. I consider how this conclusion should inform our thinking about what we owe to extremists. (shrink)

Professional codes of ethics are regarded as elements of nurses' ethical knowledge base and consequently part of their ethics education. However, research focusing on these codes from an educational viewpoint is scarce. This study explored the need and applicability of nursing codes of ethics in modern health care, their importance in the nursing ethics curriculum, and the need for development of their teaching. A total of 183 Finnish nurse educators and 212 nursing students answered three structured questions, with an opportunity (...) to justify their responses, and one open-ended question. Descriptive statistics and content analysis were used to analyse the data. The results suggest that the existence of the codes was seen as important and their applicability mainly as appropriate, despite new challenges posed by modern health care. The codes were regarded as an important part of nurses' ethics education, but current integrated teaching methods require development. (shrink)

Blockchain’s language and terminology is confusing, contested, and rapidly changing. As a hype-driven technology, Blockchain is critical to an increasing number of projects that exist in a space of regulatory uncertainty. As communities of blockchain develop and evolve, the language they use to describe these functions changes. This causes concerns when attempting to have global regulatory certainty and clarity. Regulators and communities have different approaches to blockchain language, and this causes problems because of the translation between practical use in a (...) community, and the legal effects created by regulators. Of particular concern is the lack of clear expression amongst the broader community regarding the concept of blockchain-related assets as these ‘tokens’, ‘coins’, and ‘assets’ form a key part of financial regulation. This project uses semiotics to study the diverse language associated with blockchain. This analyzes a series of self-proclaimed ‘dictionaries of blockchain’ to assess key definitions, themes, perceptions, and misconceptions present in these communities. The study involved a case analysis of the terminology used in Australia’s proposed response to blockchain in comparison with that of wider communities. When comparing this to regulatory definitions and approaches, it becomes clear that this is an area that requires further attention. This project highlights the need for regulators to understand and use common terms in blockchain regulation. It is argued that this approach facilitates a better understanding of poorly understood concepts and clearly connects the law with those it intends to target. (shrink)

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated (...) in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status. (shrink)

In many of his writings Russell developed a theory of time,highly interesting bothfrom a philosophical and from a logical point of view.Strangely enough, this has not acquired generalattention. The most important relational propertiesof the duration and points of time will be presented.In addition, Russell's considerations on the existenceand density of time points will becritically analysed and systematically reconstructed.A. G. Walker's explication of the concept of timepoint is unlike that of Russell. His theory oftime reflects the Dedekindian concept of cut.Walker's constructions (...) will be modified in a suitableway and supplemented so that it becomes possileto prove the continuity of the temporal series. (shrink)

This book introduces a set of methods and techniques for studying mathematical theories and relating them to each other through the use of Grothendieck toposes.

Psychology endeavors to develop theories of human capacities and behaviors on the basis of a variety of methodologies and dependent measures. We argue that one of the most divisive factors in psychological science is whether researchers choose to use computational modeling of theories (over and above data) during the scientific-inference process. Modeling is undervalued yet holds promise for advancing psychological science. The inherent demands of computational modeling guide us toward better science by forcing us to conceptually analyze, specify, and formalize (...) intuitions that otherwise remain unexamined—what we dub open theory. Constraining our inference process through modeling enables us to build explanatory and predictive theories. Here, we present scientific inference in psychology as a path function in which each step shapes the next. Computational modeling can constrain these steps, thus advancing scientific inference over and above the stewardship of experimental practice (e.g., preregistration). If psychology continues to eschew computational modeling, we predict more replicability crises and persistent failure at coherent theory building. This is because without formal modeling we lack open and transparent theorizing. We also explain how to formalize, specify, and implement a computational model, emphasizing that the advantages of modeling can be achieved by anyone with benefit to all. (shrink)

Although undergraduate engineering ethics courses often include the development of moral sensitivity as a learning objective and the use of active learning techniques, teaching centers on the transmission of cognitive knowledge. This article describes a complementary assignment asking students to perform an ethics “experiment” on themselves that has a potential to enhance affective learning and moral imagination. The article argues that the focus on cognitive learning may not promote, and may even impair, our efforts to foster moral sensitivity. In contrast, (...) the active learning assignments and exercises, like the ethics “experiment” discussed, offer great potential to expand the scope of instruction in engineering ethics to include ethical behavior as well as knowledge. Engineering ethics education needs to extend beyond the narrow range of human action associated with the technical work of the engineer and explore ways to draw on broader lifeworld experiences to enrich professional practice and identity. (shrink)

This major essay collection takes a fresh look at how differences among people matter for music and musical thought.

We give an explicit construction of the dependent product in an elementary topos, and a site‐theoretic description for it in the case of a Grothendieck topos. Along the way, we obtain a number of results of independent interest, including an expression for the operation of universal quantification on subobjects in terms of finite limits and power objects.

Interest in sport cyberpsychology has become more popular over the last decade, primarily due to the increased use of technology and the online world, including social media, within sport settings. In 2020, this became even more apparent for many athletes, their support teams and their sport organisations, when their professional and social worlds became cyber-dominated due to the COVID-19 pandemic. Many challenges were encountered by: the athletes, in their efforts to remain active and well during this time when all competitions (...) were cancelled and the healthcare professionals, working with these athletes, in their efforts to continue to support the athletes, when severe travel restrictions and social distancing were in place for considerable periods of time. The purpose of this paper, using a narrative review process, is to present and scrutinise an array of Internet interventions, remote psychological supports and applications that the athletes and their support personnel used to help them meet their physical, social, and emotional needs during the pandemic. The beneficial and restrictive features of these online options will be presented. Two main themes will be considered in order to focus this discussion, namely, the potential physical and mental opportunities and challenges using the online world extensively during this time presented for the individuals working in sport and suggestions for how such online interventions used by the athletes, their coaches and sport science personnel during the pandemic may be maintained in some positive ways into the future, to help the athletes prepare for their upcoming competitions, their training and their future careers when they retire from elite sport. (shrink)

What is the cognitive role of things — sometimes but not always expressed as nouns — that appear in texts? What kind of literary affordances are the material furnishings that appear in a piece of literary writing? These questions are explored in this essay through the example of John Locke's Essay Concerning Human Understanding, a long work of literary philosophy that plays with the evolving conventions of its genre. Fusing methodologies borrowed from anthropology and linguistics, this essay reveals the extent (...) and type of work done by two of Locke's things, manna and porphyry. In doing so it tests a way of tracing the cognitive action of the Essay's contemporary readership without recourse to modern experimental methods. (shrink)

“The great powers of the world may have done wonders in giving the world an industrial look, but the great gift still has to come from Africa—giving the world a more human face.”—Steve BikoUndersta...