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Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

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BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

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Philosophers have often misunderstood Kierkegaard's views on the nature and purposes of God due to a fascination with his earlier, pseudonymous works. We examine many of Kierkegaard's later works with the aim of setting forth an accurate view on this matter. The portrait of God that emerges is a personal and fiercely loving God with whom humans can and should enter into relationship. Far from advocating a fideistic faith or a cognitively unrestrained leap in the dark, we argue that Kierkegaard (...) connects this God-relationship to (a particular kind of) evidence and even knowledge. However, such evidence and knowledge – and hence God himself – may remain hidden from many individuals due to misconceptions of God and misuses of the human will. (shrink)

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Upshot: In view of Kenny’s clinical insights, Hug’s notes on the intricacies of rational vs. a-rational “knowing” in the design sciences, and Chronaki & Kynigos’s notice of mathematics teachers’ meta-communication on experiences of change, this response reframes the heuristic power of bisociation and suspension of disbelief in the light of Kelly’s notion of “as-if-ism” (constructive alternativism. Doing as-if and playing what-if, I reiterate, are critical to mitigating intra-and inter-personal relations, or meta-communicating. Their epistemic status within the radical constructivist framework is (...) cast in the context of mutually enriching conversational techniques, or language-games, inspired by Maturana’s concepts of “objectivity in parenthesis” and the multiverse. (shrink)

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Context: The idea for this article sprang from a desire to revive a conversation with the late Ernst von Glasersfeld on the heuristic function - and epistemological status - of forms of ideations that resist linguistic or empirical scrutiny. A close look into the uses of humor seemed a thread worth pursuing, albeit tenuous, to further explore some of the controversies surrounding the evocative power of the imaginal and other oblique forms of knowing characteristic of creative individuals. Problem: People generally (...) respond to humor, i.e., they are inclined to smile at things they find funny. People like to crack jokes, make puns, and, starting at age two, human infants engage in pretense or fantasy play. Research on creativity, on the other hand, has mostly scorned the trickster within. Cognitivists in particular are quick to relegate wit, whimsy, and even playfulness to the ranks of artful or poetic frivolities. Method: We use the emblems of the craftsman, the trickster, and the poet to highlight some of the oblique ways of knowing by which creative thinkers bring forth new insights. Each epitomizes dimensions intrinsic to the art of “possibilizing.” Taken together, they help us better understand what it means to be playful beyond curious, rigorous beyond reasonable, and why this should matter, even to constructivists! Results: The musings characteristic of creative individuals speak to intelligent beings’ ability to use glitches intentionally or serendipitously as a means to open up possibilities; to hold on to a thought before spelling it out; and to resist treating words or images as conventional and arbitrary signs regardless of their evocative power. To fall into nominalism, Bachelard insisted, is a poet’s nightmare! Implications: Psyche is image, said Jung, and when we feel alive we rely on the imaginal to guide our reason. Note that image is not here to be understood as a picture in the head or a photographic snapshot of the world. The imaginal does not represent, it brings forth what we understand beyond words. It does not lock us into a single mode. Instead, it is a call to be mindful, in Ellen Langer’s sense: in the present, mentally alert, and on the outlook for our psyche’s own surprising wisdom (sagacity. Constructivist content: Debates on the heuristic function and epistemological status of oblique ways of knowing have long occupied constructivist scholars. I can only guess whether my uses of Jung’s imaginal or Bachelard’s anti-nominalism would have amused or exasperated Ernst! I do know that, on occasion, Ernst the connoisseur, bricoleur, and translator allowed the rationalist-within to include the poet’s power to evoke as a legitimate form of rationality. He himself has written about oblique knowing as legit! (shrink)

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Aron Gurwitsch did not publish his Habilitationschrift, completed in 1931, or follow up its themes in his subsequent work. Only at the end of his life did he consent to its publication and, shortly before his death in 1973, reviewed the text for the present edition.

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The title of the volume is apt: Steinkraus succeeded in assembling an admirable collection, truly representative of the thought, the intellectual development and the spirit of one of the most remarkable figures of American philosophy, Borden Parker Bowne, for thirty six years--until his untimely death at 63 in 1910--a professor of philosophy at Boston University and one of the most prolific philosophic writers in America.

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The study of syntax is fundamental to linguistics and language study, but it is often taught solely within the framework of transformational grammar. This book is unique in several respects: it introduces the basic concepts used in the description of syntax, independently of any single model of grammar. Most grammatical models fail to deal adequately with one aspect of syntax or another, and the authors argue that an understanding of the concepts used in any full description of language is crucial (...) for assessing the strengths and weaknesses of formal grammars. Formal approaches to some of these concepts are critically examined. This book will train students, of either linguistics or language, to understand and make the best use of any grammar they encounter. Secondly, the book deals with the whole of syntax from immediate constituents and relations between sentences. It also examines concepts like subject and object, agent and patient, topic, comment and theme. Thirdly, there is a section on morphology, and a discussion of the relationship between syntax and morphology. As a book which explains, in a lucid and approachable way, why linguists have adopted certain solutions to problems and not others, this will be an invaluable introductory text. It is profusely illustrated with diagrams, and there are sets of exercises for every chapter which can be used in class, or by students working independently. This second edition has been extensively revised to take account of recent developments in syntactic studies. (shrink)

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Bowra (Pindar, p. 270), referring to the image of the, and to the striking impression, states ‘Pindar seems to fuse two unusually disparate images into a single result… While the sheddingof leaves implies that he would have grown old without winning any wide renown, the cock means that such renown as he would have got would have beenof little account in the Greek world at large.’ Gildersleeve's comment ad loc, ‘Thethus becomes a flower’, implies a similar assumption, that the secondimage (...) is entirely unconnected with the first. (shrink)

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Human Papillomavirus (HPV) types are sexually transmitted infections that cause a number of human cancers. According to the competitive exclusion principle in ecology, HPV types that have lower transmission probabilities and shorter durations of infection should be outcompeted by more virulent types. This, however, is not the case, as numerous HPV types co-exist, some which are less transmissible and more easily cleared than others. This paper examines whether this exception to the competitive exclusion principle can be explained by the aggregation (...) of infection with HPV types, which results in patchy spatial distributions of infection, and what implications this has for the effect of vaccination on multiple HPV types. A deterministic transmission model is presented that models the patchy distribution of infected individuals using Lloyd’s mean crowding. It is first shown that higher aggregation can result in a reduced capacity for onward transmission and reduce the required efficacy of vaccination. It is shown that greater patchiness in the distribution of lower prevalence HPV types permits co-existence. This affirms the hypothesis that the aggregation of HPV types provides an explanation for the violation of the competitive exclusion principle. Greater aggregation of lower prevalence types has important implications where type-specific HPV vaccines also offer cross-protection against non-target types. It is demonstrated that the degree of cross-protection can be less than the degree of vaccine protection conferred against directly targeted types and still result in the elimination of non-target types when these non-target types are patchily distributed. (shrink)

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The siren call of individualism is compelling. And although we have recognized its dangerous allure in the realm of adult decision-making, it has had profound and yet unnoticed dangerous effects in pediatric decision-making as well. Liberal individualism as instantiated in the best interest standard conceptualizes the child as independent and unencumbered and the goal of child rearing as rational autonomous adulthood, a characterization that is both ontologically false and normatively dangerous. Although a notion of the individuated child might have a (...) place in establishing a threshold of care obligated and enforced by the state, beyond this context we should turn our attention more explicitly to the relational interests of children. (shrink)

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In an article1 entitled Lucrèce et les éléphants, Professor Ernout has referred to recent archaeological evidence that in palaeolithic times the skeletons of mammoths were used in the construction of primitive habitations, and observes that the well-known lines of Lucretius. 532 ff. about India being so prolific inelephants that the whole land ‘milibus e multis vallo munitur eburno’ mayrefer not to anything legendary, nor to themilitary use of elephants in large numbers for frontier defence, but to a recognitionof the fact (...) that even in later times ‘les Indiens avaient pu conserver leurmode de vie et utiliser avec ses défenses d'éléphant le système de protectioninvente par leurs ancêtres, ou simplement conserver ces gigantesques os demammouths’, etc. (shrink)

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In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on (...) these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme. (shrink)

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