In this paper, we discuss the problem of communist power in so called totalitarian regimes. Inspired by strategies of explanation in contemporary science studies and by the ethnomethodological conception of social order, we suggest that the power of communists is not to be taken as an unproblematic source of explanation; rather, we take this power as something that is itself in need of being explained. We study personal narratives on political screenings that took place in Czechoslovakia in 1970 and analyze (...) how the power of communists obtained its strength from ordinary and “unremarkable” interactions between participants. The screenings are interpreted, in the terms of Bruno Latour, as “trials of strength.” We show that it was crucial for all the participants that associations, translations or mobilizations involved in making the regime real, remained partial and multiple, and not exclusive and “total” as is often assumed within dominant discourses on totalitarianism. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Trial of PatienceChristopher LewisIt seemed like after two weeks, my “flu” symptoms should have resolved. I was not eating, could not hold anything down, and had no energy. It was easy enough for my pediatrician at the time to attribute this to a common virus. This was not sitting well with my parents, however. My mother decided to take me to the emergency room and get me evaluated (...) there. The doctors there assessed me and sent me back home with a medication to help with the nausea. Later that evening, my mom gave me that medication, and it caused a seizure. She called 911, and I was brought by ambulance to the hospital. After an extensive workup, it was determined I was in liver failure related to an aneurysm in my hepatic artery. I was going to require a liver transplant if I were to live. I had to be transferred to another hospital in New York from the hospital near our home in Connecticut. I do not remember any of the details leading up to this after the seizure. I do not remember being told I needed a liver transplant and I do not remember going into surgery.My memories of these events start after the surgery. What I remember is being in the pediatric ICU and being told my mother was able to donate part of her liver to me. I had quite a lengthy recovery after this point. I spent about two months in the hospital and then went to a rehab facility where I would have to learn how to walk again and regain my strength.By the time I was discharged from the rehab facility, I had missed the last half of my 5th-grade year. By the time I was able to return to school, it was already several months into 6th grade. Slowly but surely, life was returning to normal. I was able to get back to doing the things an eleven-year-old should be doing. For twelve years after this initial transplant, I was in great health, my transplant team was happy with how I was doing, and I just required annual checkups after a while. Unfortunately, I saw as a child how fast things can change. This was once again the case. [End Page 126]I was in my last week of college classes, just about to finish my Bachelor’s degree in nursing and looking forward to starting my career as a nurse in the neuro ICU. However, I once again became acutely ill with seemingly flu-like symptoms. After a few days of dealing with these symptoms, my mother brought me to the emergency room. When we got to the emergency room, they did some initial testing and told me I would need to be admitted for antibiotic therapy. The first thought that came to my mind was, “Would I be able to be discharged in time to take my final exams next week?”Once I arrived in my hospital room, I met with my transplant team. They delivered the grave news. The imaging they had done showed that the graft artery from my original liver transplant as a child had failed. The graft had thrombosed and I had infected bilomas in my liver. Now, twelve years later, I would need to be re-listed for another transplant. I was devastated and in disbelief. I recall telling my mother, who was with me at the time, that we should hold off on telling my dad, thinking this could not be possible, and we shouldn’t worry him over something that was not necessarily true. Unfortunately, however, this was my reality. I would go on to wait a little over two years for the perfect liver from a deceased donor.The road to being listed and ultimately having a repeat transplant was not without its challenges and bumps in the road. About three months into my two-year wait for a liver transplant, I received my first offer for a liver. I went through all of the pre-op preparation and the next morning went into the OR and underwent anesthesia. However, I... (shrink)

BackgroundIn their research reports, scientists are expected to discuss limitations that their studies have. Previous research showed that often, such discussion is absent. Also, many journals emphasize the importance of avoiding overstatement of claims. We wanted to see to what extent editorial handling and peer review affects self-acknowledgment of limitations and hedging of claims.MethodsUsing software that automatically detects limitation-acknowledging sentences and calculates the level of hedging in sentences, we compared the submitted manuscripts and their ultimate publications of all randomized (...) class='Hi'>trials published in 2015 in 27 BioMed Central (BMC) journals and BMJ Open. We used mixed linear and logistic regression models, accounting for clustering of manuscript-publication pairs within journals, to quantify before-after changes in the mean numbers of limitation-acknowledging sentences, in the probability that a manuscript with zero self-acknowledged limitations ended up as a publication with at least one and in hedging scores.ResultsFour hundred forty-six manuscript-publication pairs were analyzed. The median number of manuscripts per journal was 10.5 (interquartile range 6–18). The average number of distinct limitation sentences increased by 1.39 (95% CI 1.09–1.76), from 2.48 in manuscripts to 3.87 in publications. Two hundred two manuscripts (45.3%) did not mention any limitations. Sixty-three (31%, 95% CI 25–38) of these mentioned at least one after peer review. Changes in mean hedging scores were negligible.ConclusionsOur findings support the idea that editorial handling and peer review lead to more self-acknowledgment of study limitations, but not to changes in linguistic nuance. (shrink)

Teachers in inclusive schools are often faced with the challenge of providing appropriate educational experiences for classes of students with abilities ranging from gifted to severely learning disabled. This challenge can be addressed either by the individual teacher or by a whole school approach. This paper reports on a study of the responses of teachers and parents to a trial of 'cluster grouping', as a model for meeting the educational needs of exceptional students. Data were gathered from teachers and parents (...) by questionnaire. The results remind us that there are factors, other than the strengths and weaknesses of a particular model, that can influence success. (shrink)

Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total (...) of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention or control. Fifty-eight Veterans completed pre- and post-testing. The intervention covered resilience strengths organized into four modules: engagement, social relatedness, transformation of pain and building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: Pain decreased in present severity [F = 5.02, p < 0.05, η2p = 0.08], total pain over six domains [F = 14.52, p < 0.01, η2p = 0.21], and pain interference [F = 6.82, p < 0.05, η2p = 0.11]; Affect improved in pain-related negative affect [F = 7.44, p < 0.01, η2p = 0.12], fear [F = 7.70, p < 0.01, η2p = 0.12], and distress [F = 10.87, p < 0.01, η2p = 0.16]; Well-being increased in pain mobility [F = 5.45, p < 0.05, η2p = 0.09], vitality [F = 4.54, p < 0.05, η2p = 0.07], and emotional well-being [F = 5.53, p < 0.05, η2p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth.Clinical Trial Registration: Registered with ClinicalTrials.gov. (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)

Participants who were unable to detect familiarity from masked 17 ms faces did report a vague, partial visual percept. Two experiments investigated the relative strength of the visual percept generated by famous and unfamiliar faces, using masked 17 ms exposure. Each trial presented simultaneously a famous and an unfamiliar face, one face in LVF and the other in RVF. In one task, participants responded according to which of the faces generated the stronger visual percept, and in the other task, (...) they attempted an explicit familiarity decision. The relative strength of the visual percept of the famous face compared to the unfamiliar face was moderated by response latency and participants’ attitude towards the famous person. There was also an interaction of visual field with response latency, suggesting that the right hemisphere can generate a visual percept differentiating famous from unfamiliar faces more rapidly than the left hemisphere. Participants were at chance in the explicit familiarity decision, confirming the absence of awareness of facial familiarity. (shrink)

The Clauser–Horne–Shimony–Holt (CHSH) inequality is a constraint that local hidden variable theories must obey. Quantum Mechanics predicts a violation of this inequality in certain experimental settings. Treatments of this subject frequently make simplifying assumptions about the probability spaces available to a local hidden variable theory, such as assuming the state of the system is a discrete or absolutely continuous random variable, or assuming that repeated experimental trials are independent and identically distributed. In this paper, we do two things: first, (...) show that the CHSH inequality holds even for completely general state variables in the measure-theoretic setting, and second, demonstrate how to drop the assumption of independence of subsequent trials while still being able to perform a hypothesis test that will distinguish Quantum Mechanics from local theories. The statistical strength of such a test is computed. (shrink)

Recent studies indicate that the processing of an unexpected word is costly when the initial, disconfirmed prediction was strong. This penalty was suggested to stem from commitment to the strongly predicted word, requiring its inhibition when disconfirmed. Additional studies show that comprehenders rationally adapt their predictions in different situations. In the current study, we hypothesized that since the disconfirmation of strong predictions incurs costs, it would also trigger adaptation mechanisms influencing the processing of subsequent strong predictions. In two experiments, participants (...) made speeded congruency judgments on two-word phrases in which the first word was either highly constraining or not. We manipulated the proportion of disconfirmed predictions in highly constraining contexts between participants. The results provide additional evidence of the costs associated with the disconfirmation of strong predictions. Moreover, they show a reduction in these costs when participants experience a high proportion of disconfirmed strong predictions throughout the experiment, indicating that participants adjust the strength of their predictions when strong prediction is discouraged. We formulate a Bayesian adaptation model whereby prediction failure cost is weighted by the participant’s belief about the likelihood of encountering the expected word, and show that it accounts for the trial-by-trial data. (shrink)

Physical activities are generally accepted as promoting important psychological benefits. However, studies examining martial arts as a form of physical activity and mental health have exhibited many methodological limitations in the past. Additionally, recent philosophical discussion has debated whether martial arts training promotes psychological wellbeing or illness. Self-efficacy has an important relationship with mental health and may be an important mechanism underpinning the potential of martial arts training to promote mental health. This study examined the effect of martial arts training (...) on the psychological construct of self-efficacy. A total of 283 secondary school students with a mean age of 12.76 (SD = 0.68) years were recruited to complete a time-limited (10-session) martial arts intervention, which was examined using a randomised controlled trial. Univariate ANOVAs found that the intervention improved the experimental group’s self-efficacy compared to the control group, which was sustained at follow-up. Regression analysis indicated that socio-educational status moderated this outcome. These findings support the martial arts-based intervention’s potential to improve self-efficacy and promote wellbeing through physical activity. Martial arts training may be an efficacious psychosocial treatment that can be used as a complementary approach to promote mental health. (shrink)

Empirical legal research into courts and adjudication starts with a formal model of trial courts and the nature of adjudication. This article discusses empirical legal research on trial courts and adjudication and divides them into three dimensions of analysis, macro, meso, and micro, to frame the discussion of empirical legal studies into courts and adjudication, the various methods researchers use, and significant findings. Empirical research may be theoretical, pragmatic or policy oriented. A large body of research approaches the study of (...) courts and adjudication from an organizational perspective, looking at court structures and how they affect daily operation. Examining trial court judges' approaches to their work, including adjudication, using survey research has also been undertaken in non-English speaking jurisdictions. Each type of research design has specific strengths and advantages, as well as limitations, but each contributes to advancing knowledge about the nature, role, and reality of trial courts and adjudication. (shrink)

In late antiquity Plato's philosophy became a battlefield between the competing discourses and rival intellectual paradigms represented by Hellenism and Christianity. Focusing on Theodoret of Cyrrhus' Graecarum Affectionum Curatio, Dr Siniossoglou examines the philosophical, rhetorical and political dimensions of the Neoplatonic-Christian conflict of interpretations over Plato. He shows that the apologist's aim was to procure a radical shift in Hellenic intellectual identity through the appropriation of Platonic concepts and terminology. The apologetical strategies of appropriation are confronted with the perspective of (...) the intended audience, the Hellenic elite, by means of comparative discourse analysis. The outcome is a reconstruction of a vital trial of strength between Neoplatonic hermeneutics and the Christian rhetorical mode of rewriting Plato. The volume concludes that the fundamental Hellenic-Christian opposition outweighed any linguistic merging that might have occurred between the two systems, and that this opposition outlived the dominance of Christianity in late antique society and politics. (shrink)

Empirical legal research into courts and adjudication starts with a formal model of trial courts and the nature of adjudication. This article discusses empirical legal research on trial courts and adjudication and divides them into three dimensions of analysis, macro, meso, and micro, to frame the discussion of empirical legal studies into courts and adjudication, the various methods researchers use, and significant findings. Empirical research may be theoretical, pragmatic or policy oriented. A large body of research approaches the study of (...) courts and adjudication from an organizational perspective, looking at court structures and how they affect daily operation. Examining trial court judges' approaches to their work, including adjudication, using survey research has also been undertaken in non-English speaking jurisdictions. Each type of research design has specific strengths and advantages, as well as limitations, but each contributes to advancing knowledge about the nature, role, and reality of trial courts and adjudication. (shrink)

This paper seeks to argue that although fair trial standards are commonly portrayed as a set of minimum coherent standards applicable across a range of different legal traditions, there is a tension between those standards that accentuate the importance of individual will and autonomy and those that emphasise the importance of accurate outcome through an effective defence. This tension has been managed for the most part by enabling individuals to be represented by legal counsel who present the defence on the (...) basis of their clients’ instructions. Human rights law has recognised the importance of legal assistance at trial and pre-trial stages of criminal procedures. Despite this certain developments in domestic and international criminal processes have led to a growing number of cases being decided without an effective defence being provided by legal counsel. Such cases have been disposed on the basis of defendants’ ‘consent’ and this supposed autonomy has held sway over any effective defence. The paper begins by tracing different dimensions of the fair trial standards and exposes a tension between the need for defendants to exercise autonomy over their case and the need for an effective defence. The paper then argues that the right to counsel has acted as a bridge between these two competing demands. Recent developments are then reviewed which have served to impede counsel from providing an effective defence in the interests of the client’s freedom to choose how her case should be handled. The examples examined are the growing number of cases that are pleaded or diverted out of court with no real examination of the strength of the prosecution case, the emergence of special advocates who do not take instructions from defendants and the increasing tendency for defendants to represent themselves in certain types of cases. The paper concludes by arguing that we need to make a sharper distinction between individual rights and procedural standards and argues for greater attention to be given to the latter on the design of criminal procedure. (shrink)

In 2015, a flourish of “alarums and excursions” by the scientific community propelled CRISPR/Cas9 and other new gene-editing techniques into public attention. At issue were two kinds of potential gene-editing experiments in humans: those making inheritable germ-line modifications and those designed to enhance human traits beyond what is necessary for health and healing. The scientific consensus seemed to be that while research to develop safe and effective human gene editing should continue, society's moral uncertainties about these two kinds of experiments (...) needed to be better resolved before clinical trials of either type should be attempted. In the United States, the National Academies of Science, Engineering and Medicine convened the Committee on Human Gene Editing: Scientific, Medical and Ethical Considerations to pursue that resolution. The committee's 2017 consensus report has been widely interpreted as “opening the door” to inheritable human genetic modification and holding a line against enhancement interventions. But on a close reading it does neither. There are two reasons for this eccentric conclusion, both of which depend upon the strength of the committee's commitment to engaging diverse public voices in the gene-editing policy-making process. (shrink)

Plato's dialogues are masterpieces of philosophy and literature. This insures their place in the firmament of human achievement, but it also makes their interpretation difficult. For example, does the literary artifice contribute to the philosophic argument? If it does, how does it do so and how are we to judge its contribution? Much of modern interpretation of Plato's dialogues focuses on the logical strength and direction of the philosophical arguments. One reason for this is that here we have something (...) we have means to evaluate; we can determine, for the most part, what the arguments are, whether they are consistent, and how much they demonstrate. Here we seem to stand, more or less, on a philosophical terra firma. Yet the contribution of Plato's literary artifice remains, for such interpretive efforts, a philosophical terra incognita precisely because there seem to be no evident, objective standards by which to judge this contribution. (shrink)

Importance: Given the importance of apathy for stroke, we felt it was time to scrutinize the psychometric properties of the commonly used Starkstein Apathy Scale for this purpose.Objectives: The objectives were to: estimate the extent to which the SAS items fit a hierarchical continuum of the Rasch Model; and estimate the strength of the relationships between the Rasch analyzed SAS and converging constructs related to stroke outcomes.Methods: Data was from a clinical trial of a community-based intervention targeting participation. A (...) total of 857 SAS questionnaires were completed by 238 people with stroke from up to 5 time points. SAS has 14 items, rated on a 4-point scale with higher values indicating more apathy. Psychometric properties were tested using Rasch partial-credit model, correlation, and regression. Items were rescored so higher scores are interpreted as lower apathy levels.Results: Rasch analysis indicated that the response options were disordered for 8/14 items, pointing to unreliability in the interpretation of the response options; they were consequently reduced from 4 to 3. Only 9/14 items fit the Rasch model and therefore suitable for creating a total score. The new rSAS was deemed unidimensional. Apathy was correlated weakly with anxiety/depression and uncorrelated with physical capacity. Regression showed that the effect of apathy on participation and health perception was similar for rSAS/SAS versions: R2 participation measures ranged from 0.11 to 0.29; R2 for health perception was ∼0.25. When placed on the same scale, rSAS value was 6.5 units lower than SAS value with minimal floor/ceiling effects. Estimated change over time was identical which was not substantial but greater than expected assuming no change.Conclusion: The retained items of the rSAS targeted domains of behaviors more than beliefs and results support the rSAS as a robust measure of apathy in people with chronic stroke. (shrink)

In medieval epics such as the Byzantine Digenis Akritis and the Persian Šāhnāme, dragons are usually considered to be mere opponents of the hero. But the symbolism attached to them is far from being exclusively that of a monstruous creature fighting a good hero. The motif of the three-headed dragon combines an allegorical meaning with a mythological framework. The confrontation between a dragon and an apparently weaker protagonist like a maiden or a younger son highlights the latters’ inner strength (...) and intelligence, while dangerously revealing the dragon’s possession of these human qualities. On an axiological level, the dragon’s symbolism displays the same variety: the dragon is a malevolent creature, and the archetype of the enemy, but also serves as an auxiliary to sound out men’s hearts, as in Fereydūn’s trial of his three sons. The dragon furthermore symbolizes power when painted on banners. When united to its celestial foe, the dragon’s lineage leads to the birth of the greatest hero of the Persian epic, Rostam. Thus the dragon ultimately guarantees the world’s balance between good and evil. (shrink)

BackgroundMany journals prohibit the use of declarative titles that state study findings, yet a few journals encourage or even require them. We compared the effects of a declarative versus a descriptive title on readers’ perceptions about the strength of evidence in a research abstract describing a randomized trial.MethodsStudy participants (medical or dental students or doctors attending lectures) read two abstracts describing studies of a fictitious treatment (Anticox) for a fictitious condition (Green’s syndrome). The first abstract (A1) described an uncontrolled, (...) 10-patient, case series, and the second (A2) described a randomized, placebo-controlled trial involving 48 patients. All participants rated identical A1 abstracts (with a descriptive title) to provide baseline ratings and thus reduce the effects of inter-individual variability. Participants were randomized so that half rated a version of A2 with a descriptive title and half with a declarative title. For each abstract, participants indicated their agreement with the statement “Anticox is an effective treatment for pain in Green’s syndrome” using 100 mm visual analogue scales (VAS) ranging from “disagree completely” to “agree completely.” VAS scores were measured by an investigator who was unaware of group allocation.ResultsOne hundred forty-four participants from four centres completed the study. There was no significant difference between the declarative and the descriptive title groups’ confidence in the study conclusions as expressed on VAS scales—in fact, the mean difference between A1 and A2 was smaller for the declarative title group than that for the descriptive title group (32.6 mm, SD 27.4 vs. 39.8 mm, SD 22.6, respectively, p = 0.09).ConclusionsWe found no evidence that the use of a declarative title affected readers’ perceptions about study conclusions. This suggests that editors’ fears that declarative titles might unduly influence readers’ judgements about study conclusions may be unfounded, at least in relation to reports of randomized trials. However, our study design had several limitations, and our findings may not be generalizable to other situations. (shrink)

‘Jason…chosen leader because his superior declines the honour, subordinate to his comrades, except once, in every trial of strength, skill, or courage, a great warrior only with the help of magical charms, jealous of honour but incapable of asserting it, passive in the face of crisis, timid and confused before trouble, tearful at insult, easily despondent, gracefully treacherous in his dealings with the love-sick Medea but cowering before her later threats and curses, coldly efficient in the time-serving murder of (...) an unsuspecting child (sic), reluctant even in marriage.’ So Carspecken put the case against Jason's heroism. In the face of such an indictment, Lawall's plea in mitigation, ‘it must be admitted that [Jason] often reveals the qualities of a true gentleman’, seems somehow inadequate. Criticism since Carspecken has found various overlapping categories for Jason which both take account of the earlier negative judgements and preserve the centrality of his ‘personality’ and character in the poem: Jason is the quiet diplomat who works through consensus rather than force, his is a heroism of sex-appeal, he is an anti-hero, the embodiment of Sceptic ‘suspension of judgement’, or, alternatively, he is ‘one of us’, credible and lifelike. Carspecken himself tried a different tack: the poem is concerned not with individual heroism but with the heroism of the group (cf. 1.1, 4.1773–81). (shrink)

Introduction: Alcohol approach bias, the tendency to automatically move toward alcohol cues, has been observed in people who drink heavily. However, surprisingly, some alcohol-dependent patients demonstrate an alcohol avoidance bias. This inconsistency could be explained by the clinical or demographic profile of the population studied, yet this has not been examined in approach bias modification trials to date. We aimed to determine the proportion of patients with an approach or avoidance bias, assess whether they differ on demographic and drinking (...) measures, and to examine the clinical correlates of approach bias.Method: These research questions were addressed using baseline data from 268 alcohol-dependent patients undergoing inpatient withdrawal treatment who then went on to participate in a trial of ABM.Results: At trial entry, 155 had an alcohol approach bias and 113 had an avoidance bias. These two groups did not differ on any demographic or relevant drinking measures. Approach bias was significantly and moderately associated with total standard drinks consumed in the past 30 days but no other indices of alcohol consumption or problem severity.Conclusion: Whilst the majority of alcohol-dependent patients showed an alcohol approach bias, those with an avoidance bias did not differ in demographic or clinical characteristics, and the strength of approach bias related only to recent consumption. Further research is needed to develop more accurate and personally tailored measures of approach bias, as these findings likely reflect the poor reliability of standard approach bias measures. (shrink)

Cancer chemoprevention trials test the efficacy of pharmaceutical agents in preventing cancer in at-risk research subjects who are neither patients diagnosed with the disease nor typical healthy volunteers. Such trials present unique challenges to investigators and IRB reviewers when evaluating risks and benefits, assessing informed consent, and compensating subjects. Investigators and IRBs should pay particular attention to the criteria used to define at-risk subjects and carefully assess the strength of the evidence supporting them, as this is critical (...) to evaluating the risk-benefit ratio. (shrink)

Anxiety is a common unpleasant reaction among patients undergoing surgery. Many non-pharmacological methods such as spiritual strength are effective in preoperative anxiety management. This study aimed to assess the effects of listening to Quran recitation on reducing preoperative anxiety. A systematic review was performed in Medline, EMBASE, Cochrane Library, PsycINFO, Arab World Research Source, and other relevant databases to collect the data. Randomized controlled trials about the effects of listening to Quran recitation on preoperative anxiety reduction in elective (...) surgery were selected without any language and date restriction. Interventions with self-reading/self-recitation were excluded. The Cochran’s Q statistic and the I2 index with 50% threshold were used for calculating the heterogeneity and inconsistency index. Subgroup analysis was conducted based on the surgery type. The funnel plot was used to evaluate the possibility of publication bias. Twelve studies were included in the qualitative synthesis and nine studies in the quantitative synthesis. The meta-analysis showed a significant anxiety reduction with listening to Quran recitation. The heterogeneity between the included studies was statistically significant. The pooled effect size of anxiety was d = −8.893 = −10.763 to −7.022). The subgroup analysis showed that listening to Quran recitation reduces anxiety in major and minor surgeries. There was no publication bias in the studies. The findings indicated that listening to Quran recitation can be considered a non-invasive and peaceful intervention to reduce preoperative anxiety in elective surgery. (shrink)

In this issue of the Hastings Center Report, Danielle Wenner looks at a few prominent analyses of the social value requirement for clinical research, claiming that they are all based on what she calls a transactional model of research ethics. She argues that the transactional model fails to provide a secure foundation for the social value requirement, and then, appealing to John Rawls, she argues that a more secure foundation lies in the principles of social justice. Wenner's attempt to locate (...) the source of the social value requirement raises important questions regarding its scope and strength. To determine what the social value requirement requires, we need to know why it's a requirement. Does the social value requirement apply to all trials or only to a subset? Is it a necessary condition on ethical research or an important consideration that can conflict with, and sometimes be defeated by, other considerations? Wenner's attempt to answer these questions is obscured by the fact that she mistakenly regards a minority view of research ethics as the mainstream view. Once we correct for that, her analysis of the foundation of the social value requirement provides a valuable opportunity to consider how the ethics of research as an institution might supplement or alter the ethics of individual clinical trials. (shrink)

When faced with an ambiguous pronoun, comprehenders use both multimodal cues and linguistic cues to identify the antecedent. While research has shown that gestures facilitate language comprehension, improve reference tracking, and influence the interpretation of ambiguous pronouns, literature on reference resolution suggests that a wide set of linguistic constraints influences the successful resolution of ambiguous pronouns and that linguistic cues are more powerful than some multimodal cues. To address the outstanding question of the importance of gesture as a cue in (...) reference resolution relative to cues in the speech signal, we have previously investigated the comprehension of contrastive gestures that indexed abstract referents – in this case expressions of personal preference – and found that such gestures did facilitate the resolution of ambiguous statements of preference. In this study, we extend this work to investigate whether the effect of gesture on resolution is diminished when the gesture indexes a statement that is less likely to be interpreted as the correct referent. Participants watched videos in which a speaker contrasted two ideas that were either neutral or moral acceptable). A gesture to the left or right side co-occurred with speech expressing each position. In gesture-disambiguating trials, an ambiguous phrase was accompanied by a gesture to one side or the other. In gesture non-disambiguating trials, no third gesture occurred with the ambiguous phrase. Participants were more likely to choose the idea accompanied by gesture as the stimulus speaker’s preference. We found no effect of scenario type. Regardless of whether the linguistic cue expressed a view that was morally charged or neutral, observers used gesture to understand the speaker’s opinion. This finding contributes to our understanding of the strength and range of cues, both linguistic and multimodal, that listeners use to resolve ambiguous references. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large (...) number of subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

Bornstein has proposed a manuscript submission process based on an adversary legal model, with the manuscript, like a criminal defendant, being presumed innocent unless and until proven guilty by the referees, who act as "prosecutors." The author would be provided with an opportunity for rebuttal, and the associate editor would serve as the trial judge, deciding whether the piece should ultimately be published. The editor-in-chief would hear appeals from decisions made by the associate editor. While there is much to be (...) said about this adversary approach, this paper points out certain problems in using the criminal case as a model. The most significant problem is that the burden of proof is not properly allocated. A better model would be that of the civil law suit, where the plaintiff carries the burden of proof to establish the strength of the claim . This paper also suggests certain modifications to Bornstein's proposal, such as publication of the referees' comments and the author's rebuttal. Although Bornstein's proposal, as modified herein, would not solve all of the problems Bornstein has identified with the current submission process, this paper concludes that the new procedure would do much to advance the science. (shrink)

In this essay, I suggest that the criminal trial is not only about the guilt or innocence of the defendant, but also about the character and growth of the jurors and the communities they represent. In earlier work, I have considered the potential impact of law and politics on the character of citizens, and thus on the capacity of citizens to thrive—to live full and rich human lives. Regarding the jury, I have argued that aspects of criminal trial procedure work (...) to fix in jurors a sense of agency in and responsibility for verdicts of conviction. Here, I draw on those ideas with respect to the presumption of innocence. I suggest that the presumption of innocence works not primarily as legal rule, but rather as a moral framing device—a sort of moral discomfort device—encouraging jurors to feel and bear the weight of what they do. I offer an account of character development in which virtues are conceived of not merely as modes of conduct developed through habituation and practice, but also as capacities and ways of being developed in part through understanding and experience. The criminal trial, framed by the presumption of innocence, can be an experience through which jurors and their communities, by learning what it means and feels like to carry a certain sort of moral weight, may engender a certain set of moral strengths—strengths valuable to them not just as jurors, but also as citizens, and as human beings. (shrink)

The ability to learn cause–effect relations from experience is critical for humans to behave adaptively — to choose causes that bring about desired effects. However, traditional experiments on experience-based learning involve events that are artificially compressed in time so that all learning occurs over the course of minutes. These paradigms therefore exclusively rely upon working memory. In contrast, in real-world situations we need to be able to learn cause–effect relations over days and weeks, which necessitates long-term memory. 413 participants completed (...) a smartphone study, which compared learning a cause–effect relation one trial per day for 24 days versus the traditional paradigm of 24 trials back- to- back. Surprisingly, we found few differences between the short versus long timeframes. Subjects were able to accurately detect generative and preventive causal relations, and they exhibited illusory correlations in both the short and long timeframe tasks. These results provide initial evidence that experience-based learning over long timeframes exhibits similar strengths and weaknesses as in short timeframes. However, learning over long timeframes may become more impaired with more complex tasks. (shrink)

Physical activity, body composition and sedentary behavior may affect the health of children. Therefore, this study examined the effect of an educational hybrid physical education program on physical fitness, body composition and sedentary and PA times in adolescents. A 9-month group-randomized controlled trial was conducted in 150 participants allocated into the control group and experimental group. Cardiorespiratory fitness, speed, strength, agility, flexibility and body mass index were assessed through previously validated field tests. Sedentary time, PA at school and afterschool (...) were evaluated with the Youth Activity Profile-Spain questionnaire. Significant differences were observed concerning to the CG in APA-weekend, speed-agility and agility. Regarding the intervention, cardiorespiratory fitness, speed-agility, strength, flexibility, agility, PA in school, APA-weekday, APA-weekend, APA-week, and sedentary time increased significantly in the EG. The use of a hybrid program based on teaching personal and social responsibility and gamification strategies produced enhancements in cardiorespiratory fitness, agility, speed, APA-weekdays and APA-weekends, reducing the sedentary time. (shrink)

While orthodox (Neyman-Pearson) statistical tests enjoy widespread use in science, the philosophical controversy over their appropriateness for obtaining scientific knowledge remains unresolved. I shall suggest an explanation and a resolution of this controversy. The source of the controversy, I argue, is that orthodox tests are typically interpreted as rules for making optimal decisions as to how to behave--where optimality is measured by the frequency of errors the test would commit in a long series of trials. Most philosophers of statistics, (...) however, view the task of statistical methods as providing appropriate measures of the evidential-strength that data affords hypotheses. Since tests appropriate for the behavioral-decision task fail to provide measures of evidential-strength, philosophers of statistics claim the use of orthodox tests in science is misleading and unjustified. What critics of orthodox tests overlook, I argue, is that the primary function of statistical tests in science is neither to decide how to behave nor to assign measures of evidential strength to hypotheses. Rather, tests provide a tool for using incomplete data to learn about the process that generated it. This they do, I show, by providing a standard for distinguishing differences (between observed and hypothesized results) due to accidental or trivial errors from those due to systematic or substantively important discrepancies. I propose a reinterpretation of a commonly used orthodox test to make this learning model of tests explicit. (shrink)

How can we respond in the aftermath of wrongdoing? How can social trust be restored in the wake of intense political conflict? In this challenging work, philosopher Trudy Govier explores central dilemmas of political reconciliation, employing illustrative material from Rwanda, Sierra Leone, South Africa, Australia, Canada, Peru, and elsewhere. Govier stresses that reconciliation is fundamentally about relationships. Whether through means of truth commissions, apologies, community processes, or criminal trials, the basic goal of reconciliation is improved social trust among alienated (...) individuals and groups. A major strength of Govier's approach is her creative practical framework for reflection. She explains that people should not to be identified with the roles they may have played, and she points out that, with reference to wrongs committed in political conflicts, individuals often play several roles. The perpetrators of some acts can be the victims of others; the victims in some circumstances may become responsive interveners in others. Rare is the political conflict in which one group commits all wrongs. Govier argues that, to build social trust and sustainable peace, acknowledgment of past wrongs is crucial. The need for mutuality in acknowledgment is an underappreciated aspect of the aftermath of conflicts. She further examines the themes of responsibility ; apology; forgiveness; reparations; the rehabilitation of child soldiers; the problems of monetary compensation; and truth-telling and truth commissions. Govier's lucid style and willingness to explore counterarguments make this a lively and thought-provoking work. (shrink)

The formation and recall of memories are fundamental aspects of life and help preserve the complex collection of experiences that provide us with a sense of identity and autonomy. Scientists have recently started to investigate pharmacological agents that inhibit or “dampen” the strength of memory formation and recall. The development of these memory-dampening agents has been investigated for the treatment of posttraumatic stress disorder (PTSD). Currently, these agents are being tested in multicenter clinical trials and will likely soon (...) be approved for the treatment of PTSD. With advancements in technology, more targeted memory-dampening techniques may be developed in the future. Accessibility to these agents will inevitably affect one's sense of identity and also one's sense of autonomy. Therefore, it is essential that the legal and ethical implications of using these agents be examined for governments and courts to appropriately address issues that may emerge. (shrink)

Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores (...) that indicate no reliable change in depression symptoms with a qualitative inquiry of patients’ perspectives. Methods: The study took place in the context of a Randomized Controlled Trial evaluating time-limited psychodynamic and cognitive behavioural therapy for major depression. A mixed methods study was conducted including patients’ pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients’ interviews. Findings: From the patients’ perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients’ resistance and impossibility and the context as a source of distress. “No change” in outcome scores therefore seems to involve a “partial change” when considering the patients’ perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed. (shrink)

The ArgumentThe argument developed herein, a countertheme to the Merton thesis, is that the ideal of science pursued by Galileo and his contemporaries in Italy would be unaffected by their Catholic faith if it could achieve apodictic proof in the subject of its investigations, in which case it would attain truth – the very goal sought by that faith. Unfortunately such proof was hard to come by in early seventeenth-century mechanics. A case study is proposed to show Galileo's difficulty demonstrating (...) the tensile strength of columns in mathematical physics on the basis of improper suppositions, contrasting these with the suppositions of a contemporary, Giovanni de Guevara. The case study casts new light on the subject of Galileo's atomism and its relation to the Eucharist, refuting Redondi's claim that this was the real motive behind Galileo's trial in 1633. A further lesson relating to the Merton thesis can also be drawn, namely, that while challenges to science from religious orthodoxy may appear as temporary obstacles, in the long run they are an aid to science in its efforts to bring mankind closer to the truth. (shrink)

BackgroundThe proper and ethical inclusion of PWLHIV and their young children in research is paramount to ensure valid evidence is generated to optimize treatment and care. Little empirical data exists to inform ethical considerations deemed most critical to these populations. Our study aimed to systematically review the empiric literature regarding ethical considerations for research participation of PWLHIV and their young children.MethodsWe conducted this systematic review in partnership with a medical librarian. A search strategy was designed and performed within the following (...) electronic databases: Ovid MEDLINE, Embase and CINAHL. We screened titles and abstracts using the following inclusion criteria: (1) a study population of PWLHIV or children under 5 years of age; and (2) collection of qualitative or quantitative data regarding ethics of research participation. Excluded were reviews, commentaries, policy statements, clinical care-related ethics concerns, abstracts, case studies, or studies unrelated to HIV research. Studies were appraised for quality, data were extracted, and studies were qualitatively analyzed using a principle-based ethical framework within the Belmont Report.ResultsOf the 7470 titles identified, 538 full-text articles were reviewed for eligibility and only three articles met full criteria for inclusion within this review. While we allowed for inclusion of studies involving young children born to mothers with HIV, only articles focused on PWLHIV were identified. Within the results of these studies, four themes emerged: (1) adequacy of informed consent; (2) consideration of paternal involvement; (3) balancing risks; and (4) access to research and treatment. A strength of this review is that it included perspectives of international research investigators, community leaders, and male partners. However, only two studies collected empiric data from PWLHIV regarding their experiences participating in researchConclusionResearchers and funding agencies should be aware of these considerations and appreciate the value of and critical need for formative research to ensure clinical trials involving PWLHIV promote ethical, well-informed research participation and, ultimately, improve care outcomes. More research is needed to create a comprehensive ethical framework for researchers when conducting studies with PWLHIV. (shrink)

Children’s readiness for school is often threatened by the occurrence of both externalizing and internalizing problems. Previous research has shown that Positive Behavioral Interventions and Supports (PBIS) is particularly effective for fostering children’s behavioral skills and reducing externalizing problems. However, whether PBIS can enhance children’s emotional skills and reduce internalizing problems is less clear. Therefore, TIME-IN was developed, which extends PBIS by also including emotional support systems. It was tested whether TIME-IN was effective for (a) improving emotion regulation and (b) (...) reducing depressive symptoms. Furthermore, it was tentatively explored whether TIME-IN is accompanied by more than natural fluctuations in both children’s externalizing and internalizing problems. The effectiveness of TIME-IN was evaluated in a non-randomized study, in which an intervention group was compared with a matched control group. Both research questions were addressed in a sample consisting of 81 children between 8 and 12 years of age with special educational needs. Questionnaires for teachers (i.e., TRF), children (i.e., FEEL-KJ and CDI), and their parents (i.e., CBCL) were administered at the beginning (T0) and the end of the school year (T1) using multi-informant assessment. Only indicative evidence was found for the hypothesis that TIME-IN improved children’s emotion regulation. Practical implications, strengths, and limitations were discussed.Clinical Trial Registration:This work was retrospectively registered at International Standard Registered Clinical/soCial sTudy Number (ISRCTN) registry ISRCTN54456609 (Weymeis, 2017). Registered 28 March 2017. (shrink)

In resistance training, the use of predicting proximity to momentary task failure, and repetitions in reserve scales specifically, is a growing approach to monitoring and controlling effort. However, its validity is reliant upon accuracy in the ability to predict MF which may be affected by congruence of the perception of effort compared with the actual effort required. The present study examined participants with at least 1 year of resistance training experience predicting their proximity to MF in two different experiments using (...) a deception design. Within each experiment participants performed four trials of knee extensions with single sets to their self-determined repetition maximum and MF. For the first experiment participants used loads equal to 70% of a one repetition maximum performed in a separate baseline session. Aiming to minimize participants between day variability in repetition performances, in the second separate experiment they used loads equal to 70% of their daily isometric maximum voluntary contraction. Results suggested that participants typically under predicted the number of repetitions they could perform to MF with a meta-analytic estimate across experiments of 2.0 [95%CIs 0.0 to 4.0]. Participants with at least 1 year of resistance training experience are likely not adequately accurate at gauging effort in submaximal conditions. This suggests that perceptions of effort during resistance training task performance may not be congruent with the actual effort required. This has implications for controlling, programming, and manipulating the actual effort in resistance training and potentially on the magnitude of desired adaptations such as improvements in muscular hypertrophy and strength. (shrink)

The early right anterior negativity (ERAN) in event-related potentials (ERPs) is typically elicited by syntactically unexpected events in Western tonal music. We examined how visual predictive information influences syntactic processing, how musical or non-musical cues have different effects, and how they interact with sequential effects between trials, which could modulate with the strength of the sense of established tonality. The EEG was recorded from musicians who listened to chord sequences paired with one of four types of visual stimuli; (...) two provided predictive information about the syntactic validity of the last chord through either musical notation of the whole sequence, or the word “regular” or “irregular”, while the other two, empty musical staves or a blank screen, provided no information. Half of the sequences ended with the syntactically invalid Neapolitan sixth chord, while the other half ended with the Tonic chord. Clear ERAN was observed in frontocentral electrodes in all conditions. A principal component analysis was performed on the grand average response in the audio-only condition, to separate spatio-temporal dynamics of different scalp areas as principal components and use them to extract auditory-related neural activities in the other visual-cue conditions. The first principal component (PC1) showed a symmetrical frontocentral topography, while the second (PC2) showed a right-lateralized frontal concentration. A source analysis confirmed the relative contribution of temporal sources to the former and a right frontal source to the latter. Cue predictability affected only the ERAN projected onto PC1, especially when the previous trial ended with the Tonic chord. The ERAN in PC2 was reduced in the trials following Neapolitan endings in general. However, the extent of this reduction differed between cue-types, whereby it was nearly absent when musical notation was used, regardless of whether the staves were filled with notes or empty. The results suggest that the right frontal areas carry out the primary role in musical syntactic analysis and integration of the ongoing context, which produce schematic expectations that, together with the veridical expectation incorporated by the temporal areas, inform musical syntactic processing in musicians. (shrink)

Proponents of evidence-based medicine have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on (...) evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence. (shrink)

This research topic (RT) focused on the impact of fitness on cognitive function and development in adolescents and elderly adults from the standpoint of lifespan neuroscience. Adolescent brain development is characterized by multimodal integration of brain anatomical features and function, according to accumulating evidence. The elderly, on the other hand, suffer from age-related cognitive deterioration. Fitness may be a major factor influencing brain growth and cognitive performance throughout these two critical times for neurological development. It is a multidimensional notion that (...) includes cardiovascular fitness, muscular strength and endurance, flexibility, and body composition, as well as motor fitness (balance, agility, speed, power, and coordination). Adolescents and older people may be responsive to intervention trials aimed at improving fitness levels, such as outdoor activities, cardiovascular exercise, and mind-body practice since brain network integration and neural efficiency are rapidly altered during this period. This RT investigates how fitness influences structural and functional brain development, particularly cognitive functions, and emotional health in adolescents and elderly people, as well as training strategies that may assist cognitive progress throughout this time. It includes a clinical trial (1) and original research papers (4) on the influence of fitness on cognitive function and development in adolescents and elderly adults from a lifespan neu... (shrink)

The primary focus of agricultural research and extension in eastern Africa is technology generation and dissemination. Despite prior critiques of the shortcomings of this approach, the consequences of such activities continue to be measured through the number of technologies developed and introduced into the supply chain. At best, impact is assessed by the total numbers of adopters and by the household and system factors influencing adoption. While the diffusion research tradition has made substantive advances in recent decades, attention to what (...) happens to technologies after adaptive, on-farm research trials continues to be limited in practice. While a host of newer approaches designed to correct for past shortcomings in diffusion research is now available, integrative methodologies that capitalize on the strengths of these different traditions are sorely needed. This article presents a more encompassing methodology for tracking the fate of technological interventions, illustrating the potential applications of findings for enhancing the positive impact of agricultural research and extension in the region. (shrink)